Healthcare Provider Details

I. General information

NPI: 1437163029
Provider Name (Legal Business Name): MARTIN L BASSETT MD, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 INLAND SHORES WAY N
KEIZER OR
97303-3883
US

IV. Provider business mailing address

925 COMMERCIAL ST SE STE 320
SALEM OR
97302-4173
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-2424
  • Fax: 503-589-6240
Mailing address:
  • Phone: 503-399-8105
  • Fax: 503-581-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD13526
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD13526
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: