| Doctor Name: | DALLAS SCOTT BASHAM |
| NPI Number: | 1194758029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | COA.06624-NP |
| Business Practice Address: | 350 Thomas More Pkwy Suite 160 Crestview Hills, KY - 410175465 |
| Business Phone Number: | 5132211100 |
| Business Fax Number: | 5135695297 |
| Mailing Address: | Po Box 643398, CINCINNATI |
| State: | OH |
| Postal Code: | 452643398 |
| Phone Number: | 5132211100 |
| Fax Number: | 5135695297 |
| NPI Enumeration Date: | 07/07/2006 |
| NPI Last Update Date: | 03/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | COA.06624-NP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |