Provider Demographics
NPI:1306910625
Name:BELLUR, JWALANAIAH N (MD)
Entity type:Individual
Prefix:MR
First Name:JWALANAIAH
Middle Name:N
Last Name:BELLUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BELLUR
Other - Middle Name:N
Other - Last Name:JWALANAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1301 CONCORD TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2843
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-958-4853
Practice Address - Street 1:4725 NORTH FEDERAL HWY
Practice Address - Street 2:NICU 2ND FLOOR HOLY CORSS HOSPITAL
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-776-3150
Practice Address - Fax:954-958-4853
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00481922080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine