Individual
DR. GARY D BOTIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25455 BARTON RD, STE 102B, LOMA LINDA, CA 92354-3128
(909) 558-2808
(909) 558-5599
Mailing address
25455 BARTON RD, STE 102B, LOMA LINDA, CA 92354-3128
(909) 558-2808
(909) 558-5599
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M4699
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005946
BLUE SHIELD
ID
01
—
000010005947
BLUE SHIELD
ID
01
—
000010147414
BLUE SHIELD
ID
05
—
002363100
—
ID
01
—
200011749
RAILROAD MEDICARE
ID
01
—
33555
BLUE SHIELD
ID
01
—
46995
BLUE CROSS
ID
01
—
B0891
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
02/18/2015
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