MEDICARE: DR. ROBERT L. BASHORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	ME37582	FL

General Provider Information

NPI Number	:	1154431195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. BASHORE M.D.

Provider Business Mailing Address
First Line	:	280 N SYKES CREEK PKWY
Second Line	:	SUITE A
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3491
Country	:	US
Telephone Number	:	321-452-3882
Fax Number	:	321-454-7736

Provider Business Practice Location Address
First Line	:	280 N SYKES CREEK PKWY
Second Line	:	SUITE A
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3491
Country	:	US
Telephone Number	:	321-452-3882
Fax Number	:	321-454-7736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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