Provider Demographics
NPI:1417195868
Name:BELL, WALTER DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DAVID
Last Name:BELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4392
Mailing Address - Country:US
Mailing Address - Phone:480-218-7105
Mailing Address - Fax:480-218-7108
Practice Address - Street 1:6402 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4392
Practice Address - Country:US
Practice Address - Phone:480-218-7105
Practice Address - Fax:480-218-7108
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical