Individual
R BRUCE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 DOCTORS PARK DRIVE, SUITE B, SPARTANBURG, SC 29307-1008
(864) 585-2587
Mailing address
PO BOX 277827, ATLANTA, GA 30384-7827
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
14747
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147479
—
SC
01
—
P00402263
MEDICARE RAILROAD PTAN#
SC
Enumeration date
05/16/2006
Last updated
10/30/2008
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