Basic Information
| Provider Information | |||||||||
| NPI: | 1780681403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4458 MEDICAL DR | ||||||||
| Address2: | STE 505 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106907400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 SPURS LN | ||||||||
| Address2: | STE 230B | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106907400 | ||||||||
| FaxNumber: | 2106907405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | G0352 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 8L3550 | 01 | TX | INDIVIDUAL MEDICARE PTAN | OTHER | 7422975977822902 | 05 | IL | MEDICAID | 110171901 | 05 | TX | MEDICAID | 110171902 | 05 | TX | MEDICAID | 110171904 | 05 | TX | MEDICAID | P00650984 | 01 | TX | RAILROAD MEDICARE PTAN | OTHER |