Healthcare Provider Details

I. General information

NPI: 1699160648
Provider Name (Legal Business Name): CESAR AUGUSTO TABORDA VIDARTE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 N STONE ST STE D
DELAND FL
32720-0824
US

IV. Provider business mailing address

100 WOODRUFF CIR NE STE 327
ATLANTA GA
30322-1020
US

V. Phone/Fax

Practice location:
  • Phone: 386-943-3270
  • Fax: 386-722-9112
Mailing address:
  • Phone: 407-727-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME160332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: