Organization
RIDGE PATHOLOGY CONSULTANTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY D. BOTZ M.D. (PRESIDENT)
(863) 293-1121
Entity
Organization
Contact information
Practice address
200 AVENUE F NE, DEPT. OF PATHOLOGY, WINTER HAVEN, FL 33881-4131
(863) 293-1121
(863) 291-6071
Mailing address
PO BOX 144333, ORLANDO, FL 32814-4333
(407) 422-9831
(407) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061509900
—
FL
01
—
CL6584
RAILROAD MEDICARE
—
Enumeration date
11/14/2005
Last updated
11/03/2014
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