Provider Demographics
NPI:1164441739
Name:OTERO, ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY BLVD
Mailing Address - Street 2:STE 116
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2774
Mailing Address - Country:US
Mailing Address - Phone:561-743-8516
Mailing Address - Fax:561-694-8907
Practice Address - Street 1:500 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2773
Practice Address - Country:US
Practice Address - Phone:561-744-7448
Practice Address - Fax:561-694-8907
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME60085207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE87090Medicare UPIN