Provider Demographics
NPI:1437340676
Name:GREGOIRE-BOTTEX, MARIE MYRTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MYRTHA
Last Name:GREGOIRE-BOTTEX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 BISCAYNE BLVD APT 7102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5302
Mailing Address - Country:US
Mailing Address - Phone:914-462-7411
Mailing Address - Fax:914-402-9389
Practice Address - Street 1:1951 SW 172ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5613
Practice Address - Country:US
Practice Address - Phone:914-462-7411
Practice Address - Fax:914-402-9389
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235797208000000X, 2080P0214X
MI4304301095389208000000X, 2080P0214X
FLME1386512080P0214X, 2080S0012X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1020745-00Medicaid
FLME138651OtherMEDICAL LICENCE
FL11995072OtherCAQH
NY235797OtherMEDICAL LICENSE
MI5315042896OtherCONTROLLED SUBSTANCE LICENSE
MI4301095389OtherMEDICAL LICENSE