Healthcare Provider Details

I. General information

NPI: 1891725628
Provider Name (Legal Business Name): ALAN A GOLDBLATT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 NW 40TH TER STE B
GAINESVILLE FL
32605-3500
US

IV. Provider business mailing address

PO BOX 147050 PMB 519
GAINESVILLE FL
32614-7050
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1999
  • Fax: 352-375-1677
Mailing address:
  • Phone: 352-375-0332
  • Fax: 352-375-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN GOLDBLATT
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 352-375-0332