Provider Demographics
NPI:1104859289
Name:GELIN, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:GELIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7648 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34436-2738
Mailing Address - Country:US
Mailing Address - Phone:352-726-3700
Mailing Address - Fax:352-726-8570
Practice Address - Street 1:7648 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:FLORAL CITY
Practice Address - State:FL
Practice Address - Zip Code:34436-2738
Practice Address - Country:US
Practice Address - Phone:352-726-3700
Practice Address - Fax:352-726-8570
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104859289OtherNPI
FL035931900Medicaid
FL1104859289OtherNPI