Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 00018074 | AL |
NPI | 1013991892 |
---|---|
Provider Name | Timothy David Bassett |
First Address | Tuscaloosa, AL 35406-3577 |
Second Address | Tuscaloosa, AL 35406-3577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 19/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
051527770 | (05) | AL |
51527770 | BCBS (01) | AL |
F82446 | (02) |