Healthcare Provider Details

I. General information

NPI: 1265454086
Provider Name (Legal Business Name): JASON ROGER BELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 SE STARK ST LEGACY MT. HOOD MEDICAL CENTER, EMERGENCY MEDICINE
GRESHAM OR
97030-3378
US

IV. Provider business mailing address

24800 SE STARK ST DEPARTMENT OF EMERGENCY MEDICINE
GRESHAM OR
97030-3378
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1400
  • Fax:
Mailing address:
  • Phone: 503-674-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number236196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: