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NPI Code Detail

MEDICARE: JOHN KEVYN OTERO M.D.

MEDICARE: JOHN KEVYN OTERO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician45961AL
22084P0800XPsychiatry PhysicianME90156FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265522635
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN KEVYN OTERO M.D.
Provider Business Mailing Address
First Line : 5788 ROSWELL RD
Second Line :
City : ATLANTA
State : GA
Zip : 30328-4904
Country : US
Telephone Number : 800-678-4611
Fax Number : 770-234-5326
Provider Business Practice Location Address
First Line : 4241 LOMAC ST
Second Line :
City : MONTGOMERY
State : AL
Zip : 36106-2879
Country : US
Telephone Number : 800-678-4611
Fax Number : 770-234-5326
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 12/30/2025

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