Provider Demographics
NPI:1356050447
Name:BELL, CHRISTOPHER BOYD (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BOYD
Last Name:BELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 E IRON EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-7079
Mailing Address - Country:US
Mailing Address - Phone:208-964-0151
Mailing Address - Fax:
Practice Address - Street 1:1545 E IRON EAGLE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-7079
Practice Address - Country:US
Practice Address - Phone:208-964-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13077807-1206363A00000X
IDPA-2538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant