Provider Demographics
NPI:1760470207
Name:BELL, LAUREL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
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 1:2620 E BARNETT RD STE H
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8383
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-5538
Practice Address - Street 1:2825 E. BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8179
Practice Address - Country:US
Practice Address - Phone:541-789-4963
Practice Address - Fax:541-789-4602
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058745208000000X
ORMD171377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD510110700Medicaid
MD022004300Medicaid
MDP00000707OtherRAILROAD
MD988LMedicare PIN
MDP00000707OtherRAILROAD
MD988LF530Medicare PIN