Provider Demographics
NPI:1689608705
Name:GOLDBLATT, ALAN ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ARTHUR
Last Name:GOLDBLATT
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 1:2205 NW 40TH TER STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3500
Mailing Address - Country:US
Mailing Address - Phone:352-375-0332
Mailing Address - Fax:352-375-1677
Practice Address - Street 1:24419 MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5837
Practice Address - Country:US
Practice Address - Phone:703-712-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46925207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040206100Medicaid
VA30015871050001Medicaid
FL040206100Medicaid