Healthcare Provider Details

I. General information

NPI: 1497098370
Provider Name (Legal Business Name): MITCHELL RULON BASSETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2013
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 N 500 E
LOGAN UT
84341-2400
US

IV. Provider business mailing address

1037 LAKEVIEW TER # 21
AZUSA CA
91702-2452
US

V. Phone/Fax

Practice location:
  • Phone: 435-752-1693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number9148352-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA154472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: