Individual
DR. JAMES WILLIAM BASS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 W. 1ST ST., SUITE 102, ELK CITY, OK 73644-2339
(580) 225-2515
(580) 303-5850
Mailing address
1800 W. 1ST ST., SUITE 102, ELK CITY, OK 73644-2339
(580) 225-2515
(580) 303-5850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
31130
OK
207Q00000X
Family Medicine Physician
Primary
K2844
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121294606
—
TX
01
—
514553
PHCS
TX
01
—
75-2616977-001
TRICARE
TX
01
—
8AG193
BCBS OF TEXAS
TX
01
—
TIN PLUS 002
TRICARE LAKE PALESTINE LOCATION
TX
01
—
TIN PLUS 029
TRICARE
TX
Enumeration date
04/05/2006
Last updated
03/10/2016
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