Provider Demographics
NPI:1235124736
Name:BASSMAN, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROBERT
Last Name:BASSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 411221
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-1221
Mailing Address - Country:US
Mailing Address - Phone:866-776-8150
Mailing Address - Fax:314-621-7276
Practice Address - Street 1:845 N NEW BALLAS CT STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7169
Practice Address - Country:US
Practice Address - Phone:314-475-3036
Practice Address - Fax:855-736-4151
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
144309300OtherACS DEPARTMENT OF LABOR
39607OtherGROUP HEALTH PLAN
IL236684Medicaid
MO112579OtherBCBS
A09943OtherMERCY
MO20150726Medicaid
IL04132001OtherBCBS
MO201507126Medicaid
35619OtherHEALTH CARE USA
A09943OtherMERCY
MO95340Medicare PIN
35619OtherHEALTH CARE USA
144309300OtherACS DEPARTMENT OF LABOR