Provider Demographics
NPI:1932632262
Name:BASTIAN, IAN R (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:R
Last Name:BASTIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-1440
Mailing Address - Fax:253-968-0443
Practice Address - Street 1:2817 ROCK MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8460
Practice Address - Fax:253-968-0443
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-07-03
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Provider Licenses
StateLicense IDTaxonomies
NE330152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology