Healthcare Provider Details

I. General information

NPI: 1083688782
Provider Name (Legal Business Name): CLIFFORD L GELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 OAK PARK BLVD SUITE 201
PISMO BEACH CA
93449-3264
US

IV. Provider business mailing address

921 OAK PARK BLVD SUITE 201
PISMO BEACH CA
93449-3264
US

V. Phone/Fax

Practice location:
  • Phone: 805-546-0411
  • Fax: 805-473-4891
Mailing address:
  • Phone: 805-546-0411
  • Fax: 805-473-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME73383
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number144049
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: