Provider Demographics
NPI:1073670873
Name:BELLEVILLE, BRUCE RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RAYMOND
Last Name:BELLEVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 SKIMMERHORN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6275
Mailing Address - Country:US
Mailing Address - Phone:970-223-2274
Mailing Address - Fax:
Practice Address - Street 1:2831 SKIMMERHORN ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6275
Practice Address - Country:US
Practice Address - Phone:970-223-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT97422083P0500X
CO21657208VP0000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01216571Medicaid
WA150115OtherWA L&I PROVIDER NUMBER
WA150115OtherWA L&I PROVIDER NUMBER
COCO306828Medicare PIN
MTE98740Medicare UPIN