Healthcare Provider Details

I. General information

NPI: 1013991892
Provider Name (Legal Business Name): TIMOTHY DAVID BASSETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 COMMONS NORTH LOOP
TUSCALOOSA AL
35406-3577
US

IV. Provider business mailing address

1781 COMMONS NORTH LOOP
TUSCALOOSA AL
35406-3577
US

V. Phone/Fax

Practice location:
  • Phone: 205-750-0447
  • Fax: 205-750-0276
Mailing address:
  • Phone: 205-750-0447
  • Fax: 205-750-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number00018074
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: