Provider Demographics
NPI:1730391863
Name:GARY L. HELLER, D.O., L.L.C.
Entity type:Organization
Organization Name:GARY L. HELLER, D.O., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-541-4431
Mailing Address - Street 1:7641 66TH ST. N.
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4834207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82717OtherBCBS OF FL
FLD60710Medicare UPIN
FLK4782Medicare ID - Type Unspecified