Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | M-4306 | ID |
NPI | 1003823956 |
---|---|
Provider Name | Dr. Craig B. Bass |
First Address | Boise, ID 83706-6643 |
Second Address | Boise, ID 83706-6643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C36896 | (02) | ID |