Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME57197 | FL |
NPI | 1144391277 |
---|---|
Provider Name | Dr. Robert J Bass |
First Address | Plantation, FL 33324-7808 |
Second Address | Plantation, FL 33324-7808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32631 | (02) | FL |