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General NPI Number Information
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NPI Number | 1992925051
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Entity Type | Individual
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Provider Name | WILSON NICOLAS OTERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 9149 ESTATE THOMAS PARAGON MEDICAL BUILDING SUITE 208
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City | ST. THOMAS
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State | VI
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Zip | 00802-2615
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Country | US
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Telephone | 340-714-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 12400 SW 1ST CT
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City | PLANTATION
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State | FL
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Zip | 33325-2702
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Country | US
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Telephone | 954-483-8335
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 44063
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3572
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License Number State | VI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 44063
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD00030353
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License Number State | WA
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