Healthcare Provider Details

I. General information

NPI: 1922113232
Provider Name (Legal Business Name): ROY G BASSETT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 N COURTENAY PKWY STE 101
MERRITT ISLAND FL
32953-4410
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 561-810-1777
  • Fax: 561-810-1866
Mailing address:
  • Phone: 727-322-3439
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME66781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: