Basic Information
| Provider Information | |||||||||
| NPI: | 1760419899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1480 TIMBERLANE RD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323121713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508934005 | ||||||||
| FaxNumber: | 8508939987 | ||||||||
| Practice Location | |||||||||
| Address1: | 1905 CAPITAL CIR NE | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502223937 | ||||||||
| FaxNumber: | 8508770206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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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 | 207QA0401X | ME71349 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207W00000X | ME71349 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | P00274210 | 01 | FL | RR MEDICARE | OTHER | 7066508009 | 01 | FL | CIGNA | OTHER | 1498126 | 01 | FL | GHI | OTHER | 250675100 | 05 | FL | MEDICAID |