Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DO.1658 | AL |
NPI | 1356602486 |
---|---|
Provider Name | Jamie Eudora Bass |
First Address | Mobile, AL 36617-3311 |
Second Address | Mobile, AL 36604-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 05/08/2021 |