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General NPI Number Information
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NPI Number | 1083885727
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Entity Type | Organization
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Legal Business Name | EDMUND A GELLER M D P A
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Dates
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Enumeration Date | 03/21/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 1 SW 129TH AVE SUITE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-437-7358
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Fax | 954-437-4197
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Provider Business Mailing Address
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Address Line | 1 SW 129TH AVE SUITE 200
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1761
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Country | US
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Telephone | 954-437-7358
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Fax | 954-437-4197
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Authorized Official
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Title or Position | OWNER
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Name | EDMUND A GELLER
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Credential | MD
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Telephone | 954-437-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME39306
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License Number State | FL
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