Provider Demographics
NPI:1710396692
Name:BELL, CORY (PA)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S COUNTRY CLUB DR STE 3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-5162
Mailing Address - Country:US
Mailing Address - Phone:480-827-5500
Mailing Address - Fax:480-827-5575
Practice Address - Street 1:1300 S COUNTRY CLUB DR STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5162
Practice Address - Country:US
Practice Address - Phone:480-827-5500
Practice Address - Fax:480-827-5575
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09324363A00000X
TX363AM0700X
AZ9196363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant