Provider Demographics
NPI:1659352169
Name:GELLMAN, STEVEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:GELLMAN
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:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-0707
Mailing Address - Country:US
Mailing Address - Phone:972-471-0031
Mailing Address - Fax:
Practice Address - Street 1:580 S DENTON TAP RD
Practice Address - Street 2:#123
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:972-462-0762
Practice Address - Fax:972-393-2133
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105308403Medicaid
TX105308404Medicaid
85C103Medicare ID - Type Unspecified
TX8G9118Medicare ID - Type Unspecified
TX105308403Medicaid
TX8L8730Medicare PIN