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MR. ANDREW CLYDE BASS MEDICAL DOCTOR

>> General Practice >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1912978693

Individual Registrant:
MR. ANDREW CLYDE BASS MEDICAL DOCTOR
Gender: M

Location and contact information for practice:
315 SOUTH SCRIVEN AVE  LIVE OAK, FL 32064 US
Tel: 386-362-4822  Fax: 386-364-3534

Contact information for business:
315 SOUTH SCRIVEN AVE  LIVE OAK, FL 32064 US
Tel: 386-362-4822  Fax: 386-364-3534

Registration Information:
NPI: 1912978693
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y208D00000XAllopathic & Osteopathic Physicians
General Practice
FLME0017754

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
BCBS16856FL01




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