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General NPI Number Information
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NPI Number | 1336564327
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Entity Type | Organization
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Legal Business Name | BBDL GASTRO LLC
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 02/27/2014
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Provider Practice Location Address
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Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 106
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3759
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Country | US
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Telephone | 561-737-0211
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Fax | 561-737-7433
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Provider Business Mailing Address
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Address Line | 10151 ENTERPRISE CENTER BLVD SUITE 106
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-3759
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Country | US
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Telephone | 561-737-0211
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Fax | 561-737-7433
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY TOWBIN
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Credential | M.D.
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Telephone | 561-737-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME0065968
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License Number State | FL
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