Provider Demographics
NPI:1568465755
Name:BELL, RUSSELL (DO)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:BELL
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:3203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7727
Practice Address - Country:US
Practice Address - Phone:903-882-0991
Practice Address - Fax:903-882-7751
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977028OtherTRICARE
TX129479501Medicaid
TX129479506Medicaid
TX8S6414OtherBCBS OF TEXAS
TXG46850Medicare UPIN
TX129479501Medicaid
TX129479506Medicaid
TX8S6414OtherBCBS OF TEXAS