Healthcare Provider Details

I. General information

NPI: 1285969717
Provider Name (Legal Business Name): JOSE JAVIER OTERO M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR
MIAMI FL
33176-2144
US

IV. Provider business mailing address

PO BOX 198227
ATLANTA GA
30384-8227
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3876
  • Fax:
Mailing address:
  • Phone: 786-596-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberME169324
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME169324
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME169324
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License NumberME169324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: