Elena Gines Botardo, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME66902 Issued in FL

Practice address

1381 S Patrick Dr
Patrick Afb, FL 32925

Phone

(321) 494-8241

NPI assigned

Jan 27, 2006

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Watson Clinic LLP

  • Clinical Medical Laboratory
  • Lakeland, FL
  • NPI 1558409730
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 31, 2019.

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548892800000",
    "number": "1215908421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 S PATRICK DR",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "329253606",
            "telephone_number": "321-494-8241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 S PATRICK DR",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "32925",
            "telephone_number": "321-494-8241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1381 S Patrick Dr",
            "address_purpose": "LOCATION",
            "city": "Patrick AFB",
            "state": "FL",
            "postal_code": "32925",
            "country_code": "US",
            "telephone_number": "321-494-8241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOTARDO",
        "first_name": "ELENA",
        "middle_name": "GINES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2019-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME66902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 45TH Medgrp-Patrick
• Dauri Zoraida Alvarez, M.D.
• Kyle Blasser, DO
• Archie Bockhorst, O.D
• Spencer Boone, DMD
• Wade J Bravo, PA
• Thomas James Brown, PA-C
• Jared Buchanon
• Cara Lee Caddy
• Andy Michael Campos, PA-C

• All providers in Patrick Afb, FL
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.