MEDICARE: DONFRED GERTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	G635-160-62-464-0	FL

General Provider Information

NPI Number	:	1316879596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONFRED GERTON

Provider Business Mailing Address
First Line	:	4471 41ST AVE STE 1014
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-9405
Country	:	US
Telephone Number	:	203-996-5456
Fax Number	:	877-283-6658

Provider Business Practice Location Address
First Line	:	4471 41ST AVE STE 1014
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-9405
Country	:	US
Telephone Number	:	203-996-5456
Fax Number	:	877-283-6658

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ DONFRED GERTON ” Practice Location

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