Individual
CARLOS ALBERTO BOTERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
541 S FLORIDA AVE, LAKELAND, FL 33801-5228
(863) 682-7246
(863) 682-5566
Mailing address
PO BOX 100910, ATLANTA, GA 30384-4548
(863) 682-7246
(863) 682-5566
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME72561
FL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
ME72561
FL
208VP0014X
Interventional Pain Medicine Physician
Primary
ME72561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050077125
RAILROAD MEDICARE
FL
01
—
32989
BCBS
FL
Enumeration date
12/02/2005
Last updated
02/06/2024
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