Provider Demographics
NPI:1164842225
Name:TRAVEL DOCTOR, PL
Entity type:Organization
Organization Name:TRAVEL DOCTOR, PL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GELBART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-550-2212
Mailing Address - Street 1:21301 POWERLINE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2389
Mailing Address - Country:US
Mailing Address - Phone:866-550-2212
Mailing Address - Fax:561-516-7362
Practice Address - Street 1:10970 CROSS CREEK BLVD.
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-4034
Practice Address - Country:US
Practice Address - Phone:866-550-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
FLME76511207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME76511OtherLICENCE
193400000XOtherTAXONOMY