Provider Demographics
NPI:1164560686
Name:BASS, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
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:PO BOX 36680
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-6680
Mailing Address - Country:US
Mailing Address - Phone:602-234-1991
Mailing Address - Fax:602-234-3748
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:SUITE 142
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3449
Practice Address - Country:US
Practice Address - Phone:602-234-1803
Practice Address - Fax:602-234-3748
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24598207L00000X
AZ41904207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z131782Medicare PIN