Provider Demographics
NPI:1740486893
Name:BASS, ALLYSON BRACKETT (MD)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:BRACKETT
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:130 S BEMISTON AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1913
Mailing Address - Country:US
Mailing Address - Phone:314-863-6677
Mailing Address - Fax:314-863-6695
Practice Address - Street 1:130 S BEMISTON AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1913
Practice Address - Country:US
Practice Address - Phone:314-863-6677
Practice Address - Fax:314-863-6695
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2013-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1PO52084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF87034Medicare UPIN
MO000001464Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER