Provider Demographics
NPI:1457411985
Name:GORDON BELLAH JR MD
Entity type:Organization
Organization Name:GORDON BELLAH JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-333-1800
Mailing Address - Street 1:2060 SPACE PARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3674
Mailing Address - Country:US
Mailing Address - Phone:281-333-1800
Mailing Address - Fax:281-335-1789
Practice Address - Street 1:2060 SPACE PARK DR STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3674
Practice Address - Country:US
Practice Address - Phone:281-333-1800
Practice Address - Fax:281-335-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty