MEDICARE: LEONARD C BASS MD PA

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
1	207Q00000X	Family Medicine Physician	ME14256	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1386746774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD C BASS MD PA

Provider Business Mailing Address
First Line	:	PO BOX 101330
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33310-1330
Country	:	US
Telephone Number	:	954-873-8545
Fax Number	:	954-587-7577

Provider Business Practice Location Address
First Line	:	9750 NW 45TH MNR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-1514
Country	:	US
Telephone Number	:	954-873-8545
Fax Number	:	954-587-7577

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEONARD CHANNING BASS
Credential	:	MD
Telephone Number	:	954-873-8545

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	05/25/2011

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