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General NPI Number Information
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NPI Number | 1902880933
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Entity Type | Individual
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Provider Name | CARLOS ALBERTO BOTERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 541 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33801-5228
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Country | US
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Telephone | 863-682-7246
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Fax | 863-682-5566
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Provider Business Mailing Address
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Address Line | PO BOX 100910
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City | ATLANTA
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State | GA
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Zip | 30384-4548
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Country | US
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Telephone | 863-682-7246
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Fax | 863-682-5566
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME72561
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | ME72561
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | ME72561
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License Number State | FL
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