Organization
TEXAS ARTHROSCOPIC SURGERY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELO LUIS OTERO M.D. (OWNER)
(817) 336-5633
Entity
Organization
Contact information
Practice address
800 8TH AVE, SUITE 116, FORT WORTH, TX 76104-2601
(817) 336-5633
(817) 870-9760
Mailing address
800 8TH AVE, SUITE 116, FORT WORTH, TX 76104-2601
(817) 336-5633
(817) 870-9760
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E5196
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063HT
BCBS
TX
05
—
162093201
—
TX
01
—
C54519
MEDICARE RR
—
Enumeration date
03/15/2007
Last updated
06/23/2008
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