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General NPI Number Information
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NPI Number | 1316879596
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Entity Type | Individual
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Provider Name | DONFRED GERTON
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Gender | Male
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 4471 41ST AVE STE 1014
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City | COLUMBUS
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State | NE
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Zip | 68601-9405
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Country | US
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Telephone | 203-996-5456
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Fax | 877-283-6658
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Provider Business Mailing Address
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Address Line | 4471 41ST AVE STE 1014
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City | COLUMBUS
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State | NE
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Zip | 68601-9405
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Country | US
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Telephone | 203-996-5456
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Fax | 877-283-6658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | G635-160-62-464-0
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License Number State | FL
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