Provider Demographics
NPI:1851160907
Name:BASS, ZEPHANIAS TEHRAN
Entity Type:Individual
Prefix:
First Name:ZEPHANIAS
Middle Name:TEHRAN
Last Name:BASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZEPHAIAS
Other - Middle Name:TEHRAN
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5814 SATEL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4958
Mailing Address - Country:US
Mailing Address - Phone:863-327-3638
Mailing Address - Fax:
Practice Address - Street 1:5814 SATEL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4958
Practice Address - Country:US
Practice Address - Phone:186-332-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor