Provider Demographics
NPI:1477520336
Name:GARCIA OTERO, PEDRO J (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:J
Last Name:GARCIA OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:J
Other - Last Name:GARCIA OTERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6276
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6276
Mailing Address - Country:US
Mailing Address - Phone:787-723-9626
Mailing Address - Fax:787-723-9626
Practice Address - Street 1:258 AVE DE LA CONSTITUCION
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-2204
Practice Address - Country:US
Practice Address - Phone:787-723-9626
Practice Address - Fax:787-723-9626
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10273OtherSTATE LICENCE
PR10273OtherSTATE LICENCE
PRF87316Medicare UPIN