Healthcare Provider Details

I. General information

NPI: 1144488958
Provider Name (Legal Business Name): JEFFREY GELLIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 WHITE POND DR SUITE 200
AKRON OH
44320-4205
US

IV. Provider business mailing address

570 WHITE POND DR SUITE 200
AKRON OH
44320-4205
US

V. Phone/Fax

Practice location:
  • Phone: 330-869-0954
  • Fax: 330-869-0964
Mailing address:
  • Phone: 330-869-0954
  • Fax: 330-869-0964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MB08291400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: