Healthcare Provider Details

I. General information

NPI: 1013922772
Provider Name (Legal Business Name): BARINDER PAUL BASSI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

IV. Provider business mailing address

100 S BLISS AVE
TAHLEQUAH OK
74464-2512
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-3780
  • Fax: 918-207-3781
Mailing address:
  • Phone: 918-207-3780
  • Fax: 918-207-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberT-00718
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1200357
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number309
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2012019495
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: