Provider Demographics
NPI:1942255005
Name:HELLER, GARY LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:HELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7641 66TH ST. N.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781
Mailing Address - Country:US
Mailing Address - Phone:727-541-4431
Mailing Address - Fax:727-541-1210
Practice Address - Street 1:7641 66TH ST N
Practice Address - Street 2:SUITE A
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781
Practice Address - Country:US
Practice Address - Phone:727-541-4431
Practice Address - Fax:727-541-1210
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4834207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82717OtherBCBS
FLD60710Medicare UPIN
FL82717OtherBCBS
FLK4782Medicare ID - Type Unspecified