Individual
ROBERT T. BASS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
570 JACKSONVILLE DR, UFJP BEACHES LIVER AND DIGESTIVE, JACKSONVILLE BEACH, FL 32250-3813
(904) 241-8448
(904) 244-3425
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME63940
FL
207RG0100X
Gastroenterology Physician
Primary
ME63940
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000553957B
—
GA
05
—
3730948-00
—
FL
Enumeration date
03/04/2006
Last updated
04/15/2010
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