Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 001195 | GA |
N | 111NI0900X | Internist | 001195 | GA |
N | 207R00000X | Internist | 0101251956 | VA |
N | 111NI0900X | Internist | 0101251956 | VA |
N | 207R00000X | Internist | 48080 | TN |
N | 111NI0900X | Internist | 48080 | TN |
N | 207RC0200X | Critical Care Medicine | 48080 | TN |
Y | 207RP1001X | Pulmonary Disease | 48080 | TN |
N | 207RS0012X | Sleep Medicine | 48080 | TN |
NPI | 1063639839 |
---|---|
Provider Name | Dr. Leon Charles Bass |
First Address | Kingsport, TN 37662-0009 |
Second Address | Kingsport, TN 37660-3365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063639839 | (05) | NC |
1063639839 | (05) | VA |
1528609 | (05) | TN |
7100389480 | (05) | KY |