Healthcare Provider Details

I. General information

NPI: 1851397749
Provider Name (Legal Business Name): WILLIAM RICHARD GELINAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11535 W EMERALD OAKS DR
CRYSTAL RIVER FL
34428-2815
US

IV. Provider business mailing address

11535 W EMERALD OAKS DR
CRYSTAL RIVER FL
34428-2815
US

V. Phone/Fax

Practice location:
  • Phone: 352-794-6191
  • Fax: 352-794-6193
Mailing address:
  • Phone: 352-794-6191
  • Fax: 352-794-6193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number058292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: