Provider Demographics
NPI:1073585063
Name:BELL, RICHARD T (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:BELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27211 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97448-8506
Mailing Address - Country:US
Mailing Address - Phone:541-747-8431
Mailing Address - Fax:541-747-6231
Practice Address - Street 1:1462 I ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4116
Practice Address - Country:US
Practice Address - Phone:541-747-8431
Practice Address - Fax:541-747-6231
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00039187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR043WCGHVDMedicare ID - Type Unspecified