Provider Demographics
NPI:1396208070
Name:BELL, JACKSON JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:JOSEPH
Last Name:BELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-837-8585
Mailing Address - Fax:814-837-7905
Practice Address - Street 1:UPMC KANE EMERGENCY DEPARTMENT
Practice Address - Street 2:4372 ROUTE 6
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3099
Practice Address - Country:US
Practice Address - Phone:814-837-8585
Practice Address - Fax:814-837-7905
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS021119207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program