Provider Demographics
NPI:1265628424
Name:CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:CORAL RIDGE GASTROENTEROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACG/FACP
Authorized Official - Prefix:
Authorized Official - First Name:V.
Authorized Official - Middle Name:ALIN
Authorized Official - Last Name:BOTOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-202-7850
Mailing Address - Street 1:2021 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3763
Mailing Address - Country:US
Mailing Address - Phone:954-202-7850
Mailing Address - Fax:954-202-7781
Practice Address - Street 1:2021 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3763
Practice Address - Country:US
Practice Address - Phone:954-202-7850
Practice Address - Fax:954-202-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty