Provider Demographics
NPI:1437163029
Name:BASSETT, MARTIN L (MD, PC)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:L
Last Name:BASSETT
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 COMMERCIAL ST SE STE 320
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4173
Mailing Address - Country:US
Mailing Address - Phone:503-399-8105
Mailing Address - Fax:503-581-5351
Practice Address - Street 1:5900 INLAND SHORES WAY N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3883
Practice Address - Country:US
Practice Address - Phone:503-399-2424
Practice Address - Fax:503-589-6240
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13526174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC91568Medicare UPIN