Provider Demographics
NPI:1235225376
Name:BELLAH, JACK LINN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:LINN
Last Name:BELLAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:721 RIVER DR
Practice Address - Street 2:SUITE B
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-964-6910
Practice Address - Fax:707-964-7430
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG47828207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50829Medicare UPIN