Provider Demographics
NPI:1811194772
Name:BELL, JERICHO LOREE (MD)
Entity Type:Individual
Prefix:
First Name:JERICHO
Middle Name:LOREE
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-4321
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:286 CALHOUN STATION PKWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5537
Practice Address - Country:US
Practice Address - Phone:601-200-4321
Practice Address - Fax:601-859-0159
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21064208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02284095Medicaid
AL119853Medicaid
MS02284095Medicaid
MSP01402400Medicare PIN
MS302I113531Medicare PIN
MS302I117198Medicare PIN