Healthcare Provider Details

I. General information

NPI: 1124132493
Provider Name (Legal Business Name): OTERO ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 MEDICAL DR SUITE G
ALAMOGORDO NM
88310-8703
US

IV. Provider business mailing address

2559 MEDICAL DR SUITE G
ALAMOGORDO NM
88310-8703
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-8126
  • Fax: 575-437-8205
Mailing address:
  • Phone: 575-437-8126
  • Fax: 575-437-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEFAN KOREC
Title or Position: PHYSICIAN/DIRECTOR
Credential: MD
Phone: 575-437-8126