Provider Demographics
NPI:1093125759
Name:BASSI, BRUCE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DANIEL
Last Name:BASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12058 SAN JOSE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8669
Mailing Address - Country:US
Mailing Address - Phone:888-730-5220
Mailing Address - Fax:888-524-8166
Practice Address - Street 1:12058 SAN JOSE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8669
Practice Address - Country:US
Practice Address - Phone:888-730-5220
Practice Address - Fax:888-524-8166
Is Sole Proprietor?:No
Enumeration Date:2014-05-04
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3083622084P0800X
TXT23222084P0800X
CA1606342084P0800X
FLME1295462084P0800X
MN24632084P0800X
IL036.1456632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry