Basic Information
| Provider Information | |||||||||
| NPI: | 1568465755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | RUSSELL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3203 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LINDALE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757717727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9038820991 | ||||||||
| FaxNumber: | 9038827751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K2184 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 752616977028 | 01 | TX | TRICARE | OTHER | 129479501 | 05 | TX | MEDICAID | 129479506 | 05 | TX | MEDICAID | 8S6414 | 01 | TX | BCBS OF TEXAS | OTHER |