Provider Demographics
NPI:1902035652
Name:SELLMAN, JEFF E (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:E
Last Name:SELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-558-6187
Practice Address - Street 1:909 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1251
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6187
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2017-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME116316207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL365758OtherAVMED
FL1839045OtherCIGNA
FL009320300Medicaid
FL14Q85OtherBCBS
FL5676909OtherAETNA
FLP01275217OtherRAILROAD MEDICARE
FL1839045OtherCIGNA