Provider Demographics
NPI:1023094349
Name:BOTERO, HERMAN G (DO)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:G
Last Name:BOTERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1293
Mailing Address - Country:US
Mailing Address - Phone:865-558-4400
Mailing Address - Fax:
Practice Address - Street 1:1422 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1293
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2089207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525609Medicaid
TN6016883OtherBLUECROSS BLUESHIELD
TNP01361606OtherRAILROAD MEDICARE
TN9292410OtherAETNA
TN103I206630Medicare PIN
TN9292410OtherAETNA
TNP01361606OtherRAILROAD MEDICARE