Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | AZ |
NPI | 1083677249 |
---|---|
Provider Name | Dr. Peter A Bassett |
First Address | Phoenix, AZ 85051-3265 |
Second Address | Phoenix, AZ 85051-3265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |