Individual
RANDALL DWIGHT BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1990 INDUSTRIAL BOULEVARD, HOUMA, LA 70363-7055
(985) 868-9300
(985) 851-0053
Mailing address
1990 INDUSTRIAL BOULEVARD, HOUMA, LA 70363-7055
(985) 868-9300
(985) 851-0053
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
14997R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1157694
—
LA
01
—
1900G5758Z
BC OF LA
LA
01
—
P00116891
RAILROAD MEDICARE
LA
Enumeration date
07/07/2006
Last updated
07/08/2007
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