Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | H6036 | TX |
N | 2086S0105X | Surgery of the Hand | H6036 | TX |
NPI | 1558370924 |
---|---|
Provider Name | Mr. Robert Lewis Bass |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-8802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0060LP | BCBS (01) | TX |
118580305 | (05) | TX |
F56189 | (02) | TX |
P00218438 | RRMCARE (01) | TX |