Provider Demographics
NPI:1942390570
Name:BELL, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:BELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 E 200 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2138
Mailing Address - Country:US
Mailing Address - Phone:801-596-2046
Mailing Address - Fax:801-596-3785
Practice Address - Street 1:461 E 200 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2138
Practice Address - Country:US
Practice Address - Phone:801-596-2046
Practice Address - Fax:801-596-3785
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT263912-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT080173122OtherRAILROAD MEDICARE
UT870534011128Medicaid
C68857Medicare UPIN
UTL68857Medicare UPIN
UT870534011128Medicaid