Provider Demographics
NPI:1376656694
Name:GELETY, TIMOTHY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:GELETY
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 1:1835 E CALLE DEL CIELO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5856
Mailing Address - Country:US
Mailing Address - Phone:520-326-0001
Mailing Address - Fax:520-326-7451
Practice Address - Street 1:5190 E FARNESS DR
Practice Address - Street 2:SUITE 114
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2142
Practice Address - Country:US
Practice Address - Phone:520-326-0001
Practice Address - Fax:520-326-7451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF71838Medicare UPIN
AZ27782Medicare ID - Type Unspecified