Individual
DR. OTONIEL DAVID PUERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401
(207) 907-1430
(207) 907-3508
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8941
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
34465
KY
207L00000X
Anesthesiology Physician
Primary
MD22859
ME
207LP2900X
Pain Medicine (Anesthesiology) Physician
34465
KY
Other
Enumeration date
10/04/2005
Last updated
02/03/2022
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