Provider Demographics
NPI:1780681403
Name:BELL, RANDALL C (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:C
Last Name:BELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4458 MEDICAL DR
Mailing Address - Street 2:STE 505
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3748
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:STE 230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:210-690-7405
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0352207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L3550OtherINDIVIDUAL MEDICARE PTAN
IL7422975977822902Medicaid
TX110171901Medicaid
TX110171902Medicaid
TX110171904Medicaid
TXP00650984OtherRAILROAD MEDICARE PTAN
IL7422975977822902Medicaid