Healthcare Provider Details

I. General information

NPI: 1962626564
Provider Name (Legal Business Name): JERRY C BELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 N RIDGE ROAD
MADISON OH
44057
US

IV. Provider business mailing address

7590 AUBURN RD STE 14
CONCORD TWP OH
44077-9176
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-8246
  • Fax: 440-428-8235
Mailing address:
  • Phone: 440-354-1985
  • Fax: 440-350-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-009293
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: