Healthcare Provider Details

I. General information

NPI: 1053425116
Provider Name (Legal Business Name): GREGORY MICHAEL BELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TRINIDAD DR
TIBURON CA
94920-1037
US

IV. Provider business mailing address

157 TRINIDAD DR
TIBURON CA
94920-1037
US

V. Phone/Fax

Practice location:
  • Phone: 415-435-6210
  • Fax:
Mailing address:
  • Phone: 415-435-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG63151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: