Healthcare Provider Details

I. General information

NPI: 1851375158
Provider Name (Legal Business Name): JEFFREY D. BELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3264 N. NORTH HILLS BLVD. 377TH MEDICAL GROUP
FAYETTEVILLE AR
72703-4005
US

IV. Provider business mailing address

3264 N. NORTH HILLS BLVD.
FAYETTEVILLE AR
72703-4005
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-3300
  • Fax: 479-521-4914
Mailing address:
  • Phone: 479-521-3300
  • Fax: 479-521-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2002-0497
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberK7658
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE4752
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: