Provider Demographics
NPI:1467448712
Name:BELLAN, PHILLIP MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MARTIN
Last Name:BELLAN
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 1:7474 S KIRKWOOD RD
Mailing Address - Street 2:NUMBER 104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3307
Mailing Address - Country:US
Mailing Address - Phone:281-495-7534
Mailing Address - Fax:281-575-1442
Practice Address - Street 1:7474 S KIRKWOOD RD
Practice Address - Street 2:NUMBER 104
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-3307
Practice Address - Country:US
Practice Address - Phone:281-495-7534
Practice Address - Fax:281-575-1442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21176Medicare UPIN
TXH44KMedicare ID - Type Unspecified