MEDICARE: DR. JORGE E 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
1	174400000X	Specialist	ME21884	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1083719025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE E OTERO M.D.

Provider Business Mailing Address
First Line	:	6101 WEBB RD STE 306
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2866
Country	:	US
Telephone Number	:	813-882-0141
Fax Number	:	813-885-4965

Provider Business Practice Location Address
First Line	:	6101 WEBB RD STE 306
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2866
Country	:	US
Telephone Number	:	813-882-0141
Fax Number	:	813-885-4965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	04/26/2012

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