Provider Demographics
NPI:1083674691
Name:BASS, DAVID RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAJ
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:4375 BOOTH CALLOWAY RD
Practice Address - Street 2:#307
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8359
Practice Address - Country:US
Practice Address - Phone:682-463-0400
Practice Address - Fax:682-463-0405
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG6900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141235501Medicaid
TX8740M1OtherBCBSTX
TX8740M1OtherBCBSTX
TX141235501Medicaid
TXC13246Medicare UPIN