Provider Demographics
NPI:1073596318
Name:BELL, MICHAEL J (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3761
Mailing Address - Country:US
Mailing Address - Phone:512-335-1475
Mailing Address - Fax:512-219-9701
Practice Address - Street 1:6300 LA CALMA DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3825
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:512-452-9306
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179752401Medicaid
TX8L5016OtherBCBS OF TX
TX8L5016Medicare PIN
TX179752401Medicaid
TX84P321Medicare ID - Type Unspecified