Provider Demographics
NPI:1770577975
Name:BELLINO HALL, ROSEMARY (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BELLINO HALL
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 1:4202 SW LEE BLVD
Mailing Address - Street 2:BLDG A STE 100
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8300
Mailing Address - Country:US
Mailing Address - Phone:580-353-0332
Mailing Address - Fax:580-248-8313
Practice Address - Street 1:4202 SW LEE BLVD
Practice Address - Street 2:BLDG A STE 100
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8300
Practice Address - Country:US
Practice Address - Phone:580-353-0332
Practice Address - Fax:580-248-8313
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK700041Medicare PIN