1740944610 NPI number — DEANNE MARGARET LIM BELLOSA MD

Table of content: DEANNE MARGARET LIM BELLOSA MD (NPI 1740944610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740944610 NPI number — DEANNE MARGARET LIM BELLOSA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLOSA
Provider First Name:
DEANNE MARGARET
Provider Middle Name:
LIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELLOSA
Provider Other First Name:
DEANNE
Provider Other Middle Name:
LIM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740944610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1851 N MCKENZIE ST STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLEY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36535-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-677-6825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 N MCKENZIE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOLEY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36535-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-424-1232
Provider Business Practice Location Address Fax Number:
251-424-1954
Provider Enumeration Date:
10/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  L.5915R , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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