Provider Demographics
NPI:1639296361
Name:JORGE E OTERO MD PA
Entity Type:Organization
Organization Name:JORGE E OTERO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-882-0141
Mailing Address - Street 1:6101 WEBB RD STE 306
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2866
Mailing Address - Country:US
Mailing Address - Phone:813-882-0141
Mailing Address - Fax:813-885-4965
Practice Address - Street 1:6101 WEBB RD STE 306
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2866
Practice Address - Country:US
Practice Address - Phone:813-882-0141
Practice Address - Fax:813-885-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME21884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3417Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION #
FLD53730Medicare UPIN