Provider Demographics
NPI:1871543165
Name:BALTODANO, NEYTON (MD)
Entity type:Individual
Prefix:DR
First Name:NEYTON
Middle Name:
Last Name:BALTODANO
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:PO BOX 4590
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4590
Mailing Address - Country:US
Mailing Address - Phone:352-350-8888
Mailing Address - Fax:
Practice Address - Street 1:601 E DIXIE AVE
Practice Address - Street 2:STE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5953
Practice Address - Country:US
Practice Address - Phone:352-350-8888
Practice Address - Fax:352-350-2014
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067368400Medicaid
FLD20969Medicare UPIN
FL067368400Medicaid