Provider Demographics
NPI:1083688782
Name:GELMAN, CLIFFORD L (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:L
Last Name:GELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 OAK PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3264
Mailing Address - Country:US
Mailing Address - Phone:805-546-0411
Mailing Address - Fax:805-473-4891
Practice Address - Street 1:921 OAK PARK BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3264
Practice Address - Country:US
Practice Address - Phone:805-546-0411
Practice Address - Fax:805-473-4891
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73383208600000X
CA144049208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
020044524OtherRAIL ROAD MEDICARE
FL257110201Medicaid
FL257110201Medicaid
FL43587YMedicare PIN