Provider Demographics
NPI:1851349625
Name:BEJJANI, BASSEM (MD)
Entity type:Individual
Prefix:DR
First Name:BASSEM
Middle Name:
Last Name:BEJJANI
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 1:44 W 6TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2306
Mailing Address - Country:US
Mailing Address - Phone:509-474-6840
Mailing Address - Fax:
Practice Address - Street 1:44 W 6TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2306
Practice Address - Country:US
Practice Address - Phone:509-474-6840
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS 4427170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG81357Medicare UPIN