Provider Demographics
NPI:1831191790
Name:BASSIN, ALAN S (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:BASSIN
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:PO BOX 150507
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-0507
Mailing Address - Country:US
Mailing Address - Phone:936-634-8216
Mailing Address - Fax:936-634-8723
Practice Address - Street 1:302 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3129
Practice Address - Country:US
Practice Address - Phone:936-634-8216
Practice Address - Fax:936-634-8723
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078496174400000X
TXN7677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258240600Medicaid
FL0163182OtherGHI
FL265715OtherAVMED
FL031845OtherNHP
FL46809OtherBLUECROSSBLUESHIELD
FL46809OtherBLUECROSSBLUESHIELD
FL0163182OtherGHI