Provider Demographics
NPI:1689671133
Name:BELL, JUDY ANN (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:BELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 UPPER SYRINGA HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-7932
Mailing Address - Country:US
Mailing Address - Phone:208-263-3740
Mailing Address - Fax:
Practice Address - Street 1:1327 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1735
Practice Address - Country:US
Practice Address - Phone:208-263-1435
Practice Address - Fax:208-263-7812
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F15434Medicare UPIN
ID1106086Medicare ID - Type Unspecified