Provider Demographics
NPI:1154752566
Name:BASRA, GURJEET
Entity type:Individual
Prefix:
First Name:GURJEET
Middle Name:
Last Name:BASRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 FM 528 RD
Mailing Address - Street 2:APT 13102
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4710
Mailing Address - Country:US
Mailing Address - Phone:832-651-1794
Mailing Address - Fax:
Practice Address - Street 1:12 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4127
Practice Address - Country:US
Practice Address - Phone:281-332-8571
Practice Address - Fax:281-332-8307
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant