Provider Demographics
NPI:1407851959
Name:OTERO GARCIA, JOSE E (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:OTERO GARCIA
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 1:410 AVE GENERAL VALERO
Mailing Address - Street 2:STE 201
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3988
Mailing Address - Country:US
Mailing Address - Phone:787-655-5062
Mailing Address - Fax:
Practice Address - Street 1:410 AVE GENERAL VALERO
Practice Address - Street 2:STE 201
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3988
Practice Address - Country:US
Practice Address - Phone:787-655-5062
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12317207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH75005Medicare UPIN
PR0021076Medicare ID - Type Unspecified