Individual
MR. ALFRED OTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Contact information
Practice address
1465 W US HIGHWAY 90 STE 100, LAKE CITY, FL 32055-6154
(386) 755-2268
(386) 243-8448
Mailing address
504 SW PACES GLN, LAKE CITY, FL 32024
(352) 672-0184
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 0003636
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291002100
—
FL
Enumeration date
04/16/2007
Last updated
06/12/2020
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