Basic Information
| Provider Information | |||||||||
| NPI: | 1265522635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTERO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | KEVYN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 N REO ST | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336091013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135492134 | ||||||||
| FaxNumber: | 8138644436 | ||||||||
| Practice Location | |||||||||
| Address1: | 5767 49TH ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273500450 | ||||||||
| FaxNumber: | 7275188662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME90156 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208VP0000X | ME90156 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.