Healthcare Provider Details

I. General information

NPI: 1841453636
Provider Name (Legal Business Name): JAMES BELLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COUNTY ROAD 7586
BLOOMFIELD NM
87413-4934
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-632-1801
  • Fax:
Mailing address:
  • Phone: 800-549-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0432317
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: