Provider Demographics
NPI:1497832018
Name:BELLVILLE, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:BELLVILLE
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:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-0711
Mailing Address - Country:US
Mailing Address - Phone:971-237-2418
Mailing Address - Fax:
Practice Address - Street 1:920 NW BOND ST
Practice Address - Street 2:SUITE 204B
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2762
Practice Address - Country:US
Practice Address - Phone:971-237-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49729-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry