MEDICARE: MICHAEL DAVID BASS MD

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	2085R0202X	Diagnostic Radiology Physician	U4467	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1932763984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID BASS MD

Provider Business Mailing Address
First Line	:	1320 S UNIVERSITY DR STE 500
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5732
Country	:	US
Telephone Number	:	817-321-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S MAIN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4917
Country	:	US
Telephone Number	:	817-702-1244
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	01/20/2026

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