Healthcare Provider Details

I. General information

NPI: 1437340676
Provider Name (Legal Business Name): MARIE MYRTHA GREGOIRE-BOTTEX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 SW 172ND AVE STE 3128
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

2701 BISCAYNE BLVD APT 7102
MIAMI FL
33137-5302
US

V. Phone/Fax

Practice location:
  • Phone: 914-462-7411
  • Fax: 914-402-9389
Mailing address:
  • Phone: 914-462-7411
  • Fax: 914-402-9389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME138651
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4304301095389
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number235797
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4304301095389
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number235797
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License NumberME138651
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberME138651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: