Provider Demographics
NPI:1245227198
Name:GORRELL, KELVIN W (MD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:W
Last Name:GORRELL
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 1:5119 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1996
Mailing Address - Country:US
Mailing Address - Phone:352-224-3139
Mailing Address - Fax:888-972-3813
Practice Address - Street 1:5119 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1996
Practice Address - Country:US
Practice Address - Phone:352-224-3139
Practice Address - Fax:888-972-3813
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57978207L00000X
OK34800207L00000X
FLME78192207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG99492Medicare UPIN