Healthcare Provider Details

I. General information

NPI: 1497707319
Provider Name (Legal Business Name): RICHARD J GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 HERNDON AVE
CLOVIS CA
93611-6800
US

IV. Provider business mailing address

PO BOX 11259
WESTMINISTER CA
92685-1259
US

V. Phone/Fax

Practice location:
  • Phone: 559-324-4000
  • Fax:
Mailing address:
  • Phone: 866-675-9441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG49837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: