MEDICARE: RONALD GELLES MD PA

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	302R00000X	Health Maintenance Organization	ME0013975	FL

General Provider Information

NPI Number	:	1710222757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD GELLES MD PA

Provider Business Mailing Address
First Line	:	175 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 WESTWARD DR
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5257
Country	:	US
Telephone Number	:	305-885-0515
Fax Number	:	305-888-1769

Authorized Official
Title or Position	:	MANAGER
Name	:	AIMEE VALDEZ
Credential	:
Telephone Number	:	305-885-0515

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	02/28/2013

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