Provider Demographics
NPI:1053363838
Name:OTERO, ANGELO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:LUIS
Last Name:OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2606
Mailing Address - Country:US
Mailing Address - Phone:817-336-5633
Mailing Address - Fax:817-870-9760
Practice Address - Street 1:800 8TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2606
Practice Address - Country:US
Practice Address - Phone:817-336-5633
Practice Address - Fax:817-870-9760
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5196207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8970OtherBCBS
TX8A8714Medicare PIN
B25317Medicare UPIN