Provider Demographics
NPI:1982116778
Name:GELLER, DAVID (ND)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GELLER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11665 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5313
Mailing Address - Country:US
Mailing Address - Phone:503-902-2163
Mailing Address - Fax:
Practice Address - Street 1:3449 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2508
Practice Address - Country:US
Practice Address - Phone:503-493-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4113175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath