Provider Demographics
NPI:1417103094
Name:BELLEW, JONATHAN GRATTAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:GRATTAN
Last Name:BELLEW
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 1:2860 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3605
Mailing Address - Country:US
Mailing Address - Phone:702-551-9487
Mailing Address - Fax:702-924-0634
Practice Address - Street 1:2860 E DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3605
Practice Address - Country:US
Practice Address - Phone:702-551-9487
Practice Address - Fax:702-924-0634
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1492207N00000X
NVSL0440207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine