Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 006432 | AZ |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 006432 | AZ |
NPI | 1245473537 |
---|---|
Provider Name | Richard Keith Bassett |
First Address | Prescott, AZ 86301-1427 |
Second Address | Prescott, AZ 86301-1427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
913882 | (05) | AZ |