Healthcare Provider Details

I. General information

NPI: 1376656694
Provider Name (Legal Business Name): TIMOTHY JOHN GELETY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 E FARNESS DR SUITE 114
TUCSON AZ
85712-2142
US

IV. Provider business mailing address

1835 E CALLE DEL CIELO
TUCSON AZ
85718-5856
US

V. Phone/Fax

Practice location:
  • Phone: 520-326-0001
  • Fax: 520-326-7451
Mailing address:
  • Phone: 520-326-0001
  • Fax: 520-326-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number21851
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: