Provider Demographics
NPI:1104925171
Name:BASS, ANN DOAN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:DOAN
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4278
Mailing Address - Country:US
Mailing Address - Phone:210-490-0016
Mailing Address - Fax:
Practice Address - Street 1:1314 E SONTERRA BLVD
Practice Address - Street 2:SUITE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4278
Practice Address - Country:US
Practice Address - Phone:210-490-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ77482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0422115-01Medicaid
TX0422115-01Medicaid
TX0422115-01Medicaid
TX742842145OtherGROUP TAX ID NUMBER