Basic Information
| Provider Information | |||||||||
| NPI: | 1669616066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASORA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BASORA ROVIRA | ||||||||
| OtherFirstName: | JOSE | ||||||||
| OtherMiddleName: | F | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 221 W. COLORADO BLVD. PAVILION 2 | ||||||||
| Address2: | SUITE 525 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149605681 | ||||||||
| FaxNumber: | 8178656395 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 W. COLORADO BLVD. PAVILION 2 | ||||||||
| Address2: | SUITE 525 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149605681 | ||||||||
| FaxNumber: | 8178656395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2009 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | Q5151 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | Q5151 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.