Provider Demographics
NPI:1871525253
Name:BELL, JOHN ELIJAH (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELIJAH
Last Name:BELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-0460
Mailing Address - Country:US
Mailing Address - Phone:901-235-7188
Mailing Address - Fax:866-201-2293
Practice Address - Street 1:305 LAKE DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9724
Practice Address - Country:US
Practice Address - Phone:901-235-7188
Practice Address - Fax:866-201-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000649213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3354212Medicaid
TNV07830Medicare UPIN
TN3354212Medicaid