Provider Demographics
NPI:1033118005
Name:BASS, ROBERT STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEVEN
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5742
Mailing Address - Country:US
Mailing Address - Phone:843-449-9415
Mailing Address - Fax:843-449-2160
Practice Address - Street 1:4708 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5742
Practice Address - Country:US
Practice Address - Phone:843-449-9415
Practice Address - Fax:843-449-2160
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC137352085R0001X
FLME00621232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA503356OtherBCBS
NC890694EMedicaid
SCGP0968-137355Medicaid
G2585288OtherOXFORD HEALTH
94093OtherMEDCOST
NC0694EOtherBCBS
9620580OtherGHI
MA2A7492OtherBCBS
NC890694EMedicaid