Provider Demographics
NPI:1336564327
Name:BBDL GASTRO LLC
Entity Type:Organization
Organization Name:BBDL GASTRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-737-0211
Mailing Address - Street 1:10151 ENTERPRISE CENTER BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3759
Mailing Address - Country:US
Mailing Address - Phone:561-737-0211
Mailing Address - Fax:561-737-7433
Practice Address - Street 1:10151 ENTERPRISE CENTER BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3759
Practice Address - Country:US
Practice Address - Phone:561-737-0211
Practice Address - Fax:561-737-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065968207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty