Provider Demographics
NPI:1356362081
Name:BELL, JOHNNY STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:STEPHEN
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 500
Mailing Address - Street 2:
Mailing Address - City:TOKELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98590-0500
Mailing Address - Country:US
Mailing Address - Phone:360-267-8138
Mailing Address - Fax:360-267-6217
Practice Address - Street 1:117 SPRUCE ST.
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-0000
Practice Address - Country:US
Practice Address - Phone:360-642-2662
Practice Address - Fax:360-642-2663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001380207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1077452Medicaid
WA25713OtherL & I
WA1077452Medicaid