Provider Demographics
NPI:1467409649
Name:EITZMAN, DONALD V (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:V
Last Name:EITZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:V
Other - Last Name:EITZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100296
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0296
Practice Address - Country:US
Practice Address - Phone:352-392-4193
Practice Address - Fax:352-846-3937
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83482080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040110200Medicaid
FL01620ZMedicare PIN
FLEU568ZMedicare PIN
FL040110200Medicaid