Individual
DR. ALY A. BASSAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.I.C.S.
Contact information
Practice address
1000 W G ST, SUITE 104, ELIZABETHTON, TN 37643-2959
(423) 543-4616
(423) 543-7771
Mailing address
PO BOX 640, 1000 WEST G STREET SUITE 104, ELIZABETHTON, TN 37644-0640
(423) 543-4616
(423) 543-7771
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD0000013983
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3191532
—
TN
Enumeration date
07/01/2005
Last updated
10/05/2012
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