Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 009013 | AZ |
N | 208000000X | Pediatrician | BP1-0053409 | TX |
Y | 2084N0402X | Child Neurologist | 009013 | AZ |
NPI | 1295113116 |
---|---|
Provider Name | Frederick Bassal |
First Address | Phoenix, AZ 85016-7710 |
Second Address | Phoenix, AZ 85016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 29/06/2021 |