Provider Demographics
NPI:1346293222
Name:GELDART, DONALD BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:BLAIR
Last Name:GELDART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-2966
Mailing Address - Country:US
Mailing Address - Phone:863-453-3121
Mailing Address - Fax:863-452-2823
Practice Address - Street 1:1006 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-2966
Practice Address - Country:US
Practice Address - Phone:863-453-3121
Practice Address - Fax:863-452-2823
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27412207QH0002X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080154893OtherRAILROAD MEDICARE
FL28070OtherBCBS
FL057930103Medicaid
FL057930100Medicaid
080154893OtherRAILROAD MEDICARE
FL057930103Medicaid
FL057930100Medicaid
FL28070OtherBCBS
FL28070EMedicare UPIN