Provider Demographics
NPI:1871790451
Name:BELLE ISLE, RICHARD M (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BELLE ISLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:455 PHILIP BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8768
Mailing Address - Country:US
Mailing Address - Phone:770-962-3642
Mailing Address - Fax:770-962-3643
Practice Address - Street 1:1504 N THORNTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8394
Practice Address - Country:US
Practice Address - Phone:770-962-3642
Practice Address - Fax:770-962-3643
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2025-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA204772207LP2900X
MN61260207LP2900X
GA104683208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4R013Medicare PIN