Provider Demographics
NPI:1154316578
Name:BELL, RICHARD K (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:BELL
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 1:914 W IRONWOOD DR STE 101
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4927
Mailing Address - Country:US
Mailing Address - Phone:208-765-5922
Mailing Address - Fax:208-664-3169
Practice Address - Street 1:914 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4927
Practice Address - Country:US
Practice Address - Phone:208-765-5922
Practice Address - Fax:208-664-3169
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003603700Medicaid
ID003603700Medicaid
ID1112211Medicare ID - Type Unspecified