Provider Demographics
NPI:1245270453
Name:BASSETTI, DENNIS RANDOLPH (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:RANDOLPH
Last Name:BASSETTI
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 1:4200 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1986
Mailing Address - Country:US
Mailing Address - Phone:863-402-3402
Mailing Address - Fax:863-402-3111
Practice Address - Street 1:4200 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-1986
Practice Address - Country:US
Practice Address - Phone:863-402-3402
Practice Address - Fax:863-402-3111
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45746207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28131OtherBCBS
P00237448OtherRAILROAD MEDICARE
FL28131OtherBCBS
FL28131OtherBCBS
FL040178100Medicaid
FL28131VMedicare UPIN