MEDICARE: LUIS 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	ME93871	FL
2	207Q00000X	Family Medicine Physician	ME93871	FL

General Provider Information

NPI Number	:	1902910664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS E OTERO M.D.

Provider Business Mailing Address
First Line	:	9874 SHEPARD PL
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6418
Country	:	US
Telephone Number	:	561-967-3186
Fax Number	:	561-967-3187

Provider Business Practice Location Address
First Line	:	3142 S CONGRESS AVE
Second Line	:
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-2552
Country	:	US
Telephone Number	:	561-967-3186
Fax Number	:	561-967-3187

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/24/2021

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Directions to “ LUIS E OTERO M.D.” Practice Location

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