=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942325907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTIN L. BASSETT MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 03/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 925 COMMERCIAL ST SE STE 320
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302-4173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-399-8105
-----------------------------------------------------
Fax | 503-581-5351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 947
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97308-0947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-399-8105
-----------------------------------------------------
Fax | 503-581-5351
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARTIN L BASSETT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 503-399-8105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD13526
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------