MR. ALFRED OTERO (NPI# 1801011663) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801011663 |
| Entity Type | Individual |
| Full Name | MR. ALFRED OTERO |
| Credential | PA-C, MPAS |
| Practice Address |
1465 W Us Highway 90 Ste 100 Lake City FL 32055-6154 |
| Mailing Address |
504 Sw Paces Gln Lake City FL 32024 |
| Practice Telephone | 3867552268 |
| Practice Fax Number | 3862438448 |
| Mailing Telephone | 3526720184 |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-06-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA 0003636 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 291002100 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 404 Nw Hall of Fame Dr, Lake City, FL 320554833 | 3867192540 | 3867529073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841271335 | Alfred Nmn Otero Jr. | Dentist | 6401 S Richards Ave, Santa Fe, NM 87508-4887 | 2005-11-10 |
| Street Address |
1465 W US HIGHWAY 90 STE 100 |
| City | LAKE CITY |
| State | FL |
| Zip Code | 32055-6154 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114439510 | Melissa Fay Peters | Nurse Practitioner | 5085 West Us Highway 90, Lake City, FL 32055 | 2017-10-26 |
| 1851801765 | Stephanie Jo Nogle | Occupational Therapist | Brooks Americare: 4251 Nw American Ln, #103, Lake City, FL 32055 | 2017-10-05 |
| 1831617273 | Erica Mayo | Pharmacist | 4846 Nw Lake Jeffery Rd., Lake City, FL 32055 | 2017-09-06 |
| 1144759333 | Jerry Hamilton Cheesman | Dentist | 217 Ne Franklin Sreet, Lake City, FL 32055 | 2017-06-09 |
| 1487183745 | Joshua Allore | Dentist | 2970 W Us Highway 90., Lake City, FL 32055 | 2017-06-08 |
| 1497298418 | Careing Hands | Preferred Provider Organization | 1471nw Queen Rd, Lakecity, FL 32055 | 2016-11-22 |
| 1881148278 | Corniqueca Stewart-simmons | Nurse Practitioner | 340 Nw Commerce Drive, Lake City, FL 32055 | 2016-08-15 |
| 1164809141 | Latasha Harten-jones | Licensed Practical Nurse | 443 Ne Sims Dr, Lake City, FL 32055 | 2015-04-29 |
| 1154716447 | Lindsey Morton | Counselor | 219 Se Baya Avenue, Lake City, FL 32055 | 2015-04-02 |
| 1124439351 | Tynette Jordan | Counselor | 708 N.w Wilson St., Lake City, FL 32055 | 2014-05-09 |
| Find all providers in zip 32055 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780143511 | Tara Eaddy Barrineau | Physician Assistant | 1998 Saint James Rd, Lake City, SC 29560-8626 | 2019-03-19 |
| 1235613423 | Susana Romero Martinez | Physician Assistant | 5085 W Us Highway 90, Lake City, FL 32055-8191 | 2018-09-24 |
| 1326370420 | Jerry Albert Johnstone | Physician Assistant | 1201 Enterprise Ave, Apt 610, Lake City, TX 77573 | 2010-02-01 |
| 1225241649 | John Geary Windham | Physician Assistant | 373 Se Country Club Rd, Lake City, FL 32025-4987 | 2007-05-08 |
| 1679684823 | William David Sanders | Physician Assistant | 213 Sw Main Blvd, Lake City, FL 32025 | 2006-08-31 |
| 1982691218 | Anthony R Lambert | Physician Assistant | 1289 Sw State Road 47, Lake City, FL 32025-0484 | 2005-10-03 |
| 1891795175 | John P Odonnell | Physician Assistant | 173 Nw Albritton Ln, Lake City, FL 32055-4451 | 2005-07-28 |
| 1831745710 | Caitlin Altman Jordan | Physician Assistant | 258 N Ron Mcnair Blvd, Lake City, SC 29560-2462 | 2019-08-15 |
| 1316505910 | Elizabeth Jean Halbur | Physician Assistant | 1351 W Main St, Lake City, IA 51449-1585 | 2019-05-30 |
| 1861965774 | Cole James Kriett | Physician Assistant | 500 W Grant St, Lake City, MN 55041-1143 | 2019-01-03 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.