Provider Demographics
NPI:1477553857
Name:BASS, ROBERT GENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GENE
Last Name:BASS
Suffix:JR
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 1:1202 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4089
Mailing Address - Country:US
Mailing Address - Phone:210-404-2650
Mailing Address - Fax:
Practice Address - Street 1:5670 VERBENA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1719
Practice Address - Country:US
Practice Address - Phone:210-817-4746
Practice Address - Fax:210-817-4750
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7749207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135334408Medicaid
TX00646LMedicare ID - Type Unspecified
TXG97027Medicare UPIN