Basic Information
| Provider Information | |||||||||
| NPI: | 1033118005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4708 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434499415 | ||||||||
| FaxNumber: | 8434492160 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434499415 | ||||||||
| FaxNumber: | 8434492160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 13735 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | ME0062123 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 503356 | 01 | PA | BCBS | OTHER | 890694E | 05 | NC | MEDICAID | GP0968-137355 | 05 | SC | MEDICAID | G2585288 | 01 | OXFORD HEALTH | OTHER | 94093 | 01 | MEDCOST | OTHER | 0694E | 01 | NC | BCBS | OTHER | 9620580 | 01 | GHI | OTHER | 2A7492 | 01 | MA | BCBS | OTHER |