Healthcare Provider Details

I. General information

NPI: 1821748187
Provider Name (Legal Business Name): WILLIAM BASS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 DAN DANCIGER RD STE 100
FORT WORTH TX
76133-4953
US

IV. Provider business mailing address

6601 DAN DANCIGER RD STE 100
FORT WORTH TX
76133-4953
US

V. Phone/Fax

Practice location:
  • Phone: 817-294-2531
  • Fax:
Mailing address:
  • Phone: 817-294-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV9835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: