MEDICARE: DR. JAMES DANIEL BASS M. D.

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	FL ME 078086	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P0034010	OTHER		RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518963404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANIEL BASS M. D.

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 BOTHELL EVERETT HWY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6642
Country	:	US
Telephone Number	:	425-316-5150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/16/2021

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