Provider Demographics
NPI:1154431195
Name:BASHORE, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:BASHORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:280 N SYKES CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3491
Mailing Address - Country:US
Mailing Address - Phone:321-452-3882
Mailing Address - Fax:321-454-7736
Practice Address - Street 1:280 N SYKES CREEK PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3491
Practice Address - Country:US
Practice Address - Phone:321-452-3882
Practice Address - Fax:321-454-7736
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37582208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10785Medicare ID - Type Unspecified
FLE58291Medicare UPIN