Otero, Alfred

Otero, Alfred is an individual health care provider with primary practice located at 1465 W Us Highway 90 Ste 100 , Lake City FL 32055-6154. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Otero, Alfred can be contacted via phone (386) 755-2268.

Contact Information

Primary practice address
1465 W Us Highway 90 Ste 100 Lake City FL 32055-6154
Phone: (386) 755-2268
Fax: (386) 243-8448
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA 0003636 Florida

Profile Details

NPI number 1801011663
LBN Legal business name Otero, Alfred
Credentials PA-C, MPAS
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 16th, 2007
Last updated Jun 12th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801011663 NPPES
Florida MEDICAID 291002100

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