Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | OS10371 | FL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | OS10371 | FL |
NPI | 1235399130 |
---|---|
Provider Name | Renee Marie Bassaly |
First Address | Tampa, FL 33614-4055 |
Second Address | Tampa, FL 33614-4055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2008 |
Last Update Date | 06/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003665900 | (05) | FL |