Provider Demographics
NPI:1629037023
Name:OTERO, RAUL ROGELIO (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:ROGELIO
Last Name:OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 UNIVERSITY SQUARE DRIVE
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-251-5822
Mailing Address - Fax:813-254-4597
Practice Address - Street 1:2700 UNIVERSITY SQUARE DRIVE
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF TAMPA
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5513
Practice Address - Country:US
Practice Address - Phone:813-251-5822
Practice Address - Fax:813-254-4597
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME307782085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066611400Medicaid
FLP00449371Medicare PIN
FL30298WMedicare PIN
FL300021277Medicare PIN
FL30298TMedicare PIN
FLD53934Medicare UPIN
FL30298ZMedicare PIN
FL300125438Medicare PIN
FL30298Medicare PIN
FL300024409Medicare PIN
FL300101472Medicare PIN