Provider Demographics
NPI:1497927818
Name:BASS, PERCY III (RD,LD)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:
Last Name:BASS
Suffix:III
Gender:M
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 AMHURST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2418
Mailing Address - Country:US
Mailing Address - Phone:214-264-8953
Mailing Address - Fax:
Practice Address - Street 1:1421 AMHURST DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2418
Practice Address - Country:US
Practice Address - Phone:214-264-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07665133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered