Healthcare Provider Details

I. General information

NPI: 1245541952
Provider Name (Legal Business Name): JONATHAN SCOTT BASSETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 S HIGHWAY 99
FILLMORE UT
84631-5013
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-743-5591
  • Fax:
Mailing address:
  • Phone: 717-919-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6279
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9685638-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: