Provider Demographics
NPI:1144338666
Name:ALDABUTE, MARVIN CHRISTOPHER (CRNA)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:CHRISTOPHER
Last Name:ALDABUTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100024
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0024
Mailing Address - Country:US
Mailing Address - Phone:352-243-9114
Mailing Address - Fax:352-243-7822
Practice Address - Street 1:1900 DON WICKHAM DR
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1979
Practice Address - Country:US
Practice Address - Phone:352-243-9114
Practice Address - Fax:352-243-7822
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9378975367500000X
IAD097082367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHV825ZOtherMEDICARE FCSO
FLHV825ZOtherMEDICARE FCSO
NE47-0550438-15Medicaid
NE279686Medicare ID - Type Unspecified