Provider Demographics
NPI:1174718399
Name:BASSETT, JEFFREY C (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:BASSETT
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SUPERIOR AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3656
Mailing Address - Country:US
Mailing Address - Phone:949-999-8979
Mailing Address - Fax:949-999-8970
Practice Address - Street 1:1525 SUPERIOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3656
Practice Address - Country:US
Practice Address - Phone:949-999-8979
Practice Address - Fax:949-999-8970
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD48762208800000X
IAMD-46040208800000X
390200000X
CAA104448208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program