1437340676 NPI number — DR. MARIE MYRTHA GREGOIRE-BOTTEX MD

Table of content: DR. MARIE MYRTHA GREGOIRE-BOTTEX MD (NPI 1437340676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437340676 NPI number — DR. MARIE MYRTHA GREGOIRE-BOTTEX MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGOIRE-BOTTEX
Provider First Name:
MARIE
Provider Middle Name:
MYRTHA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437340676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 BISCAYNE BLVD APT 7102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33137-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-462-7411
Provider Business Mailing Address Fax Number:
914-402-9389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1951 SW 172ND AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33029-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-462-7411
Provider Business Practice Location Address Fax Number:
914-402-9389
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  235797 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 4304301095389 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0214X , with the licence number: ME138651 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0214X , with the licence number: 4304301095389 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0214X , with the licence number: 235797 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080S0012X , with the licence number: ME138651 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME138651 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1020745-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME138651 . This is a "MEDICAL LICENCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11995072 . This is a "CAQH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 235797 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5315042896 . This is a "CONTROLLED SUBSTANCE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301095389 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 102074500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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