Provider Demographics
NPI:1730300179
Name:DESMOND P. BELL, JR., DPM, PA
Entity Type:Organization
Organization Name:DESMOND P. BELL, JR., DPM, PA
Other - Org Name:WOUND CARE ON WHEELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:904-642-4441
Mailing Address - Street 1:3787 PALM VALLEY RD
Mailing Address - Street 2:SUITE 102, PMB 326
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4183
Mailing Address - Country:US
Mailing Address - Phone:904-642-0877
Mailing Address - Fax:904-642-0785
Practice Address - Street 1:8833 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE #501
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1109
Practice Address - Country:US
Practice Address - Phone:904-642-4441
Practice Address - Fax:904-642-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002637213E00000X
FLARNP3099232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245251644OtherNPI
FL1154342558OtherNPI
FL1245251644OtherNPI
FL65526BMedicare ID - Type UnspecifiedDR. BELL
FLQ29433Medicare UPIN
FLU3832ZMedicare ID - Type UnspecifiedDE ANNA BELL
FLK6782Medicare ID - Type UnspecifiedGROUP NUMBER