Provider Demographics
NPI:1689638959
Name:BASS, NATHAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:STE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-353-2318
Mailing Address - Fax:
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:#410
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-353-2318
Practice Address - Fax:415-353-2407
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA39874207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A398740Medicaid
CAA28987Medicare UPIN
CA00A398740Medicare PIN