Provider Demographics
NPI:1619206638
Name:BRUCE R. BELLEVILLE, MD, LLC
Entity Type:Organization
Organization Name:BRUCE R. BELLEVILLE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BELLEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:970-223-2274
Mailing Address - Street 1:2831 SKIMMERHORN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6275
Mailing Address - Country:US
Mailing Address - Phone:970-223-2274
Mailing Address - Fax:970-223-2274
Practice Address - Street 1:2831 SKIMMERHORN ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6275
Practice Address - Country:US
Practice Address - Phone:970-223-2274
Practice Address - Fax:970-223-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21657208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE98740Medicare UPIN