Provider Demographics
NPI:1366533259
Name:BELL, JOHN JOSEPH JR (PAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:BELL
Suffix:JR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1358
Mailing Address - Country:US
Mailing Address - Phone:719-592-9890
Mailing Address - Fax:719-264-7910
Practice Address - Street 1:2685 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1358
Practice Address - Country:US
Practice Address - Phone:719-592-9890
Practice Address - Fax:719-264-7910
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67172Medicare UPIN