Provider Demographics
NPI:1972535417
Name:BOTE, HERBERT O (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:O
Last Name:BOTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-1534
Mailing Address - Country:US
Mailing Address - Phone:907-420-3540
Mailing Address - Fax:907-312-5881
Practice Address - Street 1:240 HOSPITAL PL STE 204
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4120
Practice Address - Fax:844-412-3943
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK8038207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1610981Medicaid
AK1610981Medicaid