MEDICARE: BEVAN VERN BASTIAN MD

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	2085R0202X	Diagnostic Radiology Physician	187675-1205	UT

General Provider Information

NPI Number	:	1821098088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVAN VERN BASTIAN MD

Provider Business Mailing Address
First Line	:	HC 64 BOX 21120
Second Line	:
City	:	AXTELL
State	:	UT
Zip	:	84621-5505
Country	:	US
Telephone Number	:	435-851-1338
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 759
Second Line	:
City	:	GUNNISON
State	:	UT
Zip	:	84634-0759
Country	:	US
Telephone Number	:	435-528-7246
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	01/28/2026

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