Healthcare Provider Details

I. General information

NPI: 1417195868
Provider Name (Legal Business Name): WALTER DAVID BELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 E SUPERSTITION SPRINGS BLVD SUITE 118
MESA AZ
85206-4392
US

IV. Provider business mailing address

6402 E SUPERSTITION SPRINGS BLVD SUITE 118
MESA AZ
85206-4392
US

V. Phone/Fax

Practice location:
  • Phone: 480-218-7105
  • Fax: 480-218-7108
Mailing address:
  • Phone: 480-218-7105
  • Fax: 480-218-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4315
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: