Healthcare Provider Details

I. General information

NPI: 1265204994
Provider Name (Legal Business Name): RICHARD BASSETT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE STE 330
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD STE 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax:
Mailing address:
  • Phone: 602-406-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9723
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9723
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: