Provider Demographics
NPI:1407233653
Name:BASS, NOOR ALAIN (DO)
Entity Type:Individual
Prefix:DR
First Name:NOOR
Middle Name:ALAIN
Last Name:BASS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 S RESERVE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3103
Mailing Address - Country:US
Mailing Address - Phone:406-327-3057
Mailing Address - Fax:406-327-3231
Practice Address - Street 1:1211 S RESERVE ST STE 101
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3103
Practice Address - Country:US
Practice Address - Phone:406-327-3057
Practice Address - Fax:406-327-3231
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT66718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine