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NPI Code Detail

MEDICARE: JAMIE EUDORA BASS D.O.

MEDICARE: JAMIE EUDORA BASS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS19438FL
2207QG0300XGeriatric Medicine (Family Medicine) PhysicianOS19438FL
3207Q00000XFamily Medicine PhysicianDO.000463LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356602486
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE EUDORA BASS D.O.
Provider Business Mailing Address
First Line : 1395 NW 167TH ST
Second Line :
City : MIAMI GARDENS
State : FL
Zip : 33169-5710
Country : US
Telephone Number : 305-628-6117
Fax Number : 305-393-5989
Provider Business Practice Location Address
First Line : 501 LAPALCO BLVD
Second Line :
City : GRETNA
State : LA
Zip : 70056-7336
Country : US
Telephone Number : 504-393-4376
Fax Number : 504-930-4307
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2012
Last Update Date : 01/06/2026

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