Provider Demographics
NPI:1821091869
Name:BASS, PAOLA REESE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:REESE
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAOLA
Other - Middle Name:C
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:210 WESTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1928
Mailing Address - Country:US
Mailing Address - Phone:334-793-5074
Mailing Address - Fax:334-793-6460
Practice Address - Street 1:210 WESTSIDE DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1928
Practice Address - Country:US
Practice Address - Phone:334-793-5074
Practice Address - Fax:334-793-6460
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110114694OtherRAILROAD MEDICARE
AL000030196Medicaid
ALG14628Medicare UPIN
AL000030196Medicaid