Provider Demographics
NPI:1942265798
Name:BASS, BARRY J (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:BASS
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 1:312 EAST RENFRO
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-293-9200
Mailing Address - Fax:877-838-0751
Practice Address - Street 1:312 E RENFRO ST
Practice Address - Street 2:SUITE 109
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3947
Practice Address - Country:US
Practice Address - Phone:817-293-9200
Practice Address - Fax:877-838-0751
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA11254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00182185OtherMEDICARE RAILROAD
TX165043401Medicaid
TX8B8221Medicare PIN
TXA11254Medicare UPIN