Provider Demographics
NPI:1194905984
Name:BASEMAN, DANIEL G (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:BASEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:70 NEELY RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4267
Practice Address - Country:US
Practice Address - Phone:828-883-5620
Practice Address - Fax:828-884-8801
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC010462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7305554OtherCIGNA
NC166KAOtherBLUE CROSS BLUE SHIELD
NC9550745OtherAETNA
FL1168717OtherGATEWAY HEALTH
NC5917841Medicaid
NC7305554OtherCIGNA