MEDICARE: DR. CESAR AUGUSTO TABORDA VIDARTE M.D

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
1	207RG0100X	Gastroenterology Physician	ME160332	FL

General Provider Information

NPI Number	:	1699160648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CESAR AUGUSTO TABORDA VIDARTE M.D

Provider Business Mailing Address
First Line	:	100 WOODRUFF CIR NE STE 327
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1020
Country	:	US
Telephone Number	:	407-727-5658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1070 N STONE ST STE D
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-3270
Fax Number	:	386-722-9112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	06/01/2026

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