MEDICARE: DR. DWIGHT R. 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	207QA0505X	Adult Medicine Physician	C22433	CA

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	:	1689712317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT R. BASS M.D.

Provider Business Mailing Address
First Line	:	3600 POWER INN RD STE G
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3826
Country	:	US
Telephone Number	:	916-454-1423
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 POWER INN RD STE G
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-3826
Country	:	US
Telephone Number	:	916-454-1423
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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