Provider Demographics
NPI:1821002403
Name:BASSETT, KENT LAMAR (MD)
Entity Type:Individual
Prefix:MR
First Name:KENT
Middle Name:LAMAR
Last Name:BASSETT
Suffix:
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 1:1300 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-7912
Mailing Address - Fax:425-454-7034
Practice Address - Street 1:1300 116TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-7912
Practice Address - Fax:425-454-7034
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018638207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB163OtherBLUE SHIELD
WA8543308Medicaid
WA8543308Medicaid
WAB163OtherBLUE SHIELD