Provider Demographics
NPI:1538117205
Name:BELL, GREGORY DEAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEAN
Last Name:BELL
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 1:525 LILLY RD NE
Mailing Address - Street 2:210
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5101
Mailing Address - Country:US
Mailing Address - Phone:360-413-8550
Mailing Address - Fax:360-413-8827
Practice Address - Street 1:525 LILLY RD NE
Practice Address - Street 2:210
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5101
Practice Address - Country:US
Practice Address - Phone:360-413-8550
Practice Address - Fax:360-413-8827
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8205221Medicaid
WA8205221Medicaid
WAG42866Medicare UPIN