Healthcare Provider Details

I. General information

NPI: 1215924709
Provider Name (Legal Business Name): EDMUND ALAN GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SW 129TH AVE SUITE 200
PEMBROKE PINES FL
33027-1761
US

IV. Provider business mailing address

1 SW 129TH AVE SUITE 200
PEMBROKE PINES FL
33027-1761
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-7358
  • Fax: 954-437-4197
Mailing address:
  • Phone: 954-437-7358
  • Fax: 954-437-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME0039306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: