MEDICARE: DR. JONATHAN GRATTAN BELLEW DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	DO1492	NV

General Provider Information

NPI Number	:	1417103094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GRATTAN BELLEW DO

Provider Business Mailing Address
First Line	:	2860 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3605
Country	:	US
Telephone Number	:	702-551-9487
Fax Number	:	702-924-0634

Provider Business Practice Location Address
First Line	:	2860 E DESERT INN RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3605
Country	:	US
Telephone Number	:	702-551-9487
Fax Number	:	702-924-0634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	07/07/2021

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