Healthcare Provider Details

I. General information

NPI: 1104859289
Provider Name (Legal Business Name): JOHN D. GELIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 S FLORIDA AVE
FLORAL CITY FL
34436-2738
US

IV. Provider business mailing address

7648 S FLORIDA AVE
FLORAL CITY FL
34436-2738
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-3700
  • Fax: 352-726-8570
Mailing address:
  • Phone: 352-726-3700
  • Fax: 352-726-8570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME24036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: