MEDICARE: DR. JUAN R 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	8189	PR

General Provider Information

NPI Number	:	1871590968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN R OTERO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9236
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9236
Country	:	US
Telephone Number	:	787-746-7057
Fax Number	:	787-746-7057

Provider Business Practice Location Address
First Line	:	CONSOLIDATED MALL AVE GAUTIER BENITEZ
Second Line	:	SUITE C-28
City	:	CAGUAS
State	:	PR
Zip	:	00725-0000
Country	:	US
Telephone Number	:	787-746-7057
Fax Number	:	787-746-7057

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/08/2010

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