Provider Demographics
NPI:1831190529
Name:SEROT, DONALD I (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:I
Last Name:SEROT
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 1:2135 HARDEN BLVD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5918
Mailing Address - Country:US
Mailing Address - Phone:863-687-1250
Mailing Address - Fax:863-687-1258
Practice Address - Street 1:2135 HARDEN BLVD
Practice Address - Street 2:BUILDING C
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-5918
Practice Address - Country:US
Practice Address - Phone:863-687-1250
Practice Address - Fax:863-687-1258
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-95826207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56680OtherBCBS OF FLORIDA
FL276452100Medicaid
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL1497748743OtherGROUP NPI NUMBER
FL276452100Medicaid
FL56680OtherBCBS OF FLORIDA