Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 006606 | OR |
NPI | 1003245143 |
---|---|
Provider Name | Dr. Jerry Bass |
First Address | Redmond, OR 97756-7929 |
Second Address | Redmond, OR 97756-7929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 08/11/2013 |