Provider Demographics
NPI:1003878042
Name:BASS, JAMES WILLIAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:BASS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 W. 1ST ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-2339
Mailing Address - Country:US
Mailing Address - Phone:580-225-2515
Mailing Address - Fax:580-303-5850
Practice Address - Street 1:1800 W. 1ST ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-2339
Practice Address - Country:US
Practice Address - Phone:580-225-2515
Practice Address - Fax:580-303-5850
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2844207Q00000X
OK31130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AG193OtherBCBS OF TEXAS
TXTIN PLUS 002OtherTRICARE LAKE PALESTINE LOCATION
TX514553OtherPHCS
TXTIN PLUS 029OtherTRICARE
TX75-2616977-001OtherTRICARE
TX121294606Medicaid
TXTIN PLUS 029OtherTRICARE
TX8C0239Medicare PIN
TX514553OtherPHCS
TX8AG193OtherBCBS OF TEXAS
TX75-2616977-001OtherTRICARE
TXP00663446Medicare PIN