Provider Demographics
NPI:1669433207
Name:BASSETT, CECIL EMERSON (MD)
Entity type:Individual
Prefix:DR
First Name:CECIL
Middle Name:EMERSON
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 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:6401 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-4341
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-586-5963
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN296364OtherAMERICA'S PPO
MN4242545OtherAETNA
MN0712893OtherMEDICA
MN07F94BAOtherBCBS OF MN
MN110658OtherUCARE
MNHP15846OtherHEALTHPARTNERS
MN1008220OtherPREFERRED ONE
MNF30906Medicare UPIN
MNP00239641Medicare ID - Type UnspecifiedMEDICARE RR