Individual
THEODORE B GELLERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, MSC10-5610 2-ACC, ALBUQUERQUE, NM 87106-2745
(505) 272-6901
Mailing address
800 SALAMANCA ST NW, LOS RANCHOS DE ALBUQUERQUE, NM 87107-5620
(505) 345-0330
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA2007-0036
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
995993
UNMH
NM
Enumeration date
02/06/2008
Last updated
07/14/2023
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