Healthcare Provider Details

I. General information

NPI: 1295822245
Provider Name (Legal Business Name): MARTIN ISRAEL GELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR 1A71
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

PO BOX 581200
SALT LAKE CITY UT
84158-1200
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7553
  • Fax:
Mailing address:
  • Phone: 801-213-3800
  • Fax: 801-585-3655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number153279-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: