Provider Demographics
NPI:1982662722
Name:SELANDER, GUY T (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:T
Last Name:SELANDER
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 1:1731 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8928
Mailing Address - Country:US
Mailing Address - Phone:904-725-0200
Mailing Address - Fax:904-721-5711
Practice Address - Street 1:1731 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8928
Practice Address - Country:US
Practice Address - Phone:904-725-0200
Practice Address - Fax:904-721-5711
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 10521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371620101Medicaid
FLP00320800Medicare PIN
D52935Medicare UPIN
FL371620101Medicaid