Provider Demographics
NPI:1548454424
Name:ROBERT L BASS MD PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:ROBERT L BASS MD PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-4500
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:214-239-4500
Mailing Address - Fax:214-239-4504
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-712-9408
Practice Address - Fax:972-712-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH60362086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060LPOtherBCBS
TX118580305Medicaid
TXP00218438OtherRAILROAD MEDICARE
TXP00218438OtherRAILROAD MEDICARE
TX118580305Medicaid