Provider Demographics
NPI:1679573588
Name:SOTERES, DANIEL FLETCHER (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:FLETCHER
Last Name:SOTERES
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 1:2709 N TEJON STREET
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6231
Mailing Address - Country:US
Mailing Address - Phone:719-473-0872
Mailing Address - Fax:719-630-3658
Practice Address - Street 1:2709 N TEJON STREET
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6231
Practice Address - Country:US
Practice Address - Phone:719-473-0872
Practice Address - Fax:719-630-3658
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43625207KA0200X
LA024632207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA57393Medicaid
CO56536836Medicaid
H24975Medicare UPIN
806487Medicare PIN