Healthcare Provider Details

I. General information

NPI: 1356312185
Provider Name (Legal Business Name): GEORGE GELLERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 AINSWORTH DR STE A
PRESCOTT AZ
86301-1623
US

IV. Provider business mailing address

PO BOX 10880
PRESCOTT AZ
86304-0880
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-6025
  • Fax: 928-777-2423
Mailing address:
  • Phone: 928-759-5987
  • Fax: 928-458-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21918
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: