Healthcare Provider Details

I. General information

NPI: 1801358148
Provider Name (Legal Business Name): MANUEL E BOROBIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 SW 16TH ST STE 5270
GAINESVILLE FL
32608-1128
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-1471
  • Fax:
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME156261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: