Provider Demographics
NPI:1336124130
Name:JASSIN, BASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:BASEM
Middle Name:
Last Name:JASSIN
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 1:818 W ENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-3810
Mailing Address - Country:US
Mailing Address - Phone:972-875-9700
Mailing Address - Fax:972-875-9721
Practice Address - Street 1:818 W ENNIS AVE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3810
Practice Address - Country:US
Practice Address - Phone:972-875-9700
Practice Address - Fax:972-875-9721
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3693207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0047JGOtherBCBS IND #
TX040017501OtherRAILROAD MC
TX153978501Medicaid
TXH70576Medicare UPIN
TX153978501Medicaid