Doctor Name: | MR. ANDREW CLYDE BASS |
NPI Number: | 1912978693 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MEDICAL DOCTOR |
License Number: | ME0017754 |
Business Practice Address: | 315 South Scriven Ave Live Oak, FL - 32064 |
Business Phone Number: | 3863624822 |
Business Fax Number: | 3863643534 |
Mailing Address: | 315 South Scriven Ave, LIVE OAK |
State: | FL |
Postal Code: | 32064 |
Phone Number: | 3863624822 |
Fax Number: | 3863643534 |
NPI Enumeration Date: | 01/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME0017754 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |