Provider Demographics
NPI: | 1942463799 |
---|---|
Name: | BELL, ADAM D (DO) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ADAM |
Middle Name: | D |
Last Name: | BELL |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 742941 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30374-2941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 315 E ELM ST STE 350 |
Practice Address - Street 2: | |
Practice Address - City: | CALDWELL |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83605-4881 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-459-0028 |
Practice Address - Fax: | 208-504-4311 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-07-02 |
Last Update Date: | 2023-03-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ID | O-0733 | 208600000X, 208600000X |
MI | 5101017597 | 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | 1942463799 | Other | REGENCE BLUE SHIELD |
ID | 1942463799 | Medicaid | |
ID | 2029364 | Other | BLUE CROSS |
WA | 1942463799 | Medicaid | |
ID | 2029364 | Other | BLUE CROSS |
ID | 0318263 | Other | WA L & INDUSTRIES |
ID | 20003125 | Medicare PIN |