Basic Information
| Provider Information | |||||||||
| NPI: | 1699266874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GESELMAN | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 GAFFNEY RD # 7440USA | ||||||||
| Address2: | |||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997035002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615603 | ||||||||
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| Practice Location | |||||||||
| Address1: | FORT RICHARDSON TROOP MEDICAL CLINIC 786 D STREET | ||||||||
| Address2: | |||||||||
| City: | JOINT BASE ELMENDORF RICHARDSON | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073840600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2018 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32271 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.