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General NPI Number Information
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NPI Number | 1124018114
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Entity Type | Individual
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Provider Name | GARY D BOTIMER MD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 25455 BARTON RD STE 102B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3128
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Country | US
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Telephone | 909-558-2808
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Fax | 909-558-5599
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Provider Business Mailing Address
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Address Line | 25455 BARTON RD STE 102B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3128
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Country | US
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Telephone | 909-558-2808
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Fax | 909-558-5599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M4699
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License Number State | ID
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