Provider Demographics
NPI:1548562143
Name:BASS, JOHN WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2398 E CAMELBACK RD
Mailing Address - Street 2:980
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-9001
Mailing Address - Country:US
Mailing Address - Phone:602-485-1010
Mailing Address - Fax:602-485-5079
Practice Address - Street 1:2398 E. CAMELBACK RD
Practice Address - Street 2:980
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016
Practice Address - Country:US
Practice Address - Phone:602-485-1010
Practice Address - Fax:602-485-5079
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14161261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical