Provider Demographics
NPI:1588762702
Name:SELLMAN, GARY K (MD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:K
Last Name:SELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6257 WHITE HORSE ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611
Mailing Address - Country:US
Mailing Address - Phone:864-246-6060
Mailing Address - Fax:864-246-0495
Practice Address - Street 1:6257 WHITE HORSE ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611
Practice Address - Country:US
Practice Address - Phone:864-246-6060
Practice Address - Fax:864-246-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC12697207Q00000X
SC126973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC126973Medicaid
SC126973Medicaid
SCC727890281Medicare PIN