Doctor Name: | JAMES JEFFREY BASS |
NPI Number: | 1336130079 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | R2C49 |
Business Practice Address: | 1201 Hauck Dr Rolla, MO - 654014900 |
Business Phone Number: | 5733648818 |
Business Fax Number: | 5733684422 |
Mailing Address: | 1201 Hauck Dr, ROLLA |
State: | MO |
Postal Code: | 654014900 |
Phone Number: | 5733648818 |
Fax Number: | 5733684422 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 01/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | R2C49 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |