Provider Demographics
NPI:1538126685
Name:ELTON, DONALD ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ROBERT
Last Name:ELTON
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 1:3480 POLYNESIAN ISLE BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1818
Mailing Address - Country:US
Mailing Address - Phone:407-507-2615
Mailing Address - Fax:407-507-2616
Practice Address - Street 1:3480 POLYNESIAN ISLE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746
Practice Address - Country:US
Practice Address - Phone:407-507-2615
Practice Address - Fax:407-507-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62191207RP1001X
SC14158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166915OtherMIDSOUTH
SC290011458OtherRAIL ROAD MEDICARE
SC75086OtherMEDCOST
SC141581Medicaid
SCS380410OtherHEALTH SOURCE
SC155386100OtherUS DEPARTMENT OF LABOR
SC141581Medicaid
SCE71188Medicare UPIN