Individual
DR. NATHAN PATRICK WIDBOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7031 SW 62ND AVE, SOUTH MIAMI, FL 33143-4701
(305) 284-7761
Mailing address
7031 SW 62ND AVE, SOUTH MIAMI, FL 33143-4701
(305) 284-7761
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
OS13591
FL
207Q00000X
Family Medicine Physician
OS13591
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/11/2012
Last updated
02/26/2020
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