Basic Information
| Provider Information | |||||||||
| NPI: | 1730140435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASHOR | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | BLAKE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 RUSHOLME AVE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528030000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634217702 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1227 RUSHOLME AVE | ||||||||
| Address2: | GENESIS EAST HOSPITAL | ||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 52803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634217681 | ||||||||
| FaxNumber: | 5634217719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 03053 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2145078 | 05 | IA | MEDICAID | 0145078 | 05 | IA | MEDICAID |