Provider Demographics
NPI:1194799338
Name:BASS, JOSEPH EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:BASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6887
Mailing Address - Country:US
Mailing Address - Phone:573-248-5304
Mailing Address - Fax:573-248-5311
Practice Address - Street 1:6000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6887
Practice Address - Country:US
Practice Address - Phone:573-248-5304
Practice Address - Fax:573-248-5311
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23720AL2085R0202X
MO20170220282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891756JMedicaid
AL009940090Medicaid
AL009940090Medicaid
ALG46132Medicare UPIN
AL051550184Medicare ID - Type Unspecified