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NPI Code Detail

MEDICARE: CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC

MEDICARE: CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1265628424
Entity Type Code : Organization
Provider Name (Legal Business Name) : CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC
Provider Business Mailing Address
First Line : 2021 E COMMERCIAL BLVD
Second Line : SUITE 202
City : FT LAUDERDALE
State : FL
Zip : 33308-3763
Country : US
Telephone Number : 954-202-7850
Fax Number : 954-202-7781
Provider Business Practice Location Address
First Line : 2021 E COMMERCIAL BLVD
Second Line : SUITE 202
City : FT LAUDERDALE
State : FL
Zip : 33308-3763
Country : US
Telephone Number : 954-202-7850
Fax Number : 954-202-7781
Authorized Official
Title or Position : FACG/FACP
Name : V. ALIN BOTOMAN
Credential : M.D.
Telephone Number : 954-202-7850
Provider Enumeration Date : 09/21/2007
Last Update Date : 01/09/2008

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Directions to “CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC ” Practice Location

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