=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194979641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RANDALL C. BELL, M.D., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2008
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4410 MEDICAL DR SUITE 440
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-692-9400
-----------------------------------------------------
Fax | 210-692-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4410 MEDICAL DR SUITE 440
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-692-9400
-----------------------------------------------------
Fax | 210-692-9601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. CLAIRE CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-692-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | G0352
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------