Doctor Name: | JACQUELINE BLUTCHER GOLLMAN |
NPI Number: | 1215358981 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | ME 0037797 |
Business Practice Address: | 205 Martin Luther King, Jr. St. No. Pinellas County Health Department St. Petersburg, FL - 337013109 |
Business Phone Number: | 7278246900 |
Business Fax Number: | |
Mailing Address: | P.o. Box 290919, TEMPLE TERRACE |
State: | FL |
Postal Code: | 336870919 |
Phone Number: | 8139887844 |
Fax Number: | 8139847161 |
NPI Enumeration Date: | 12/26/2013 |
NPI Last Update Date: | 12/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME 0037797 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |