Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2089 | TN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 2089 | TN |
NPI | 1023094349 |
---|---|
Provider Name | Dr. Herman G Botero |
First Address | Knoxville, TN 37909-1293 |
Second Address | Knoxville, TN 37909-1293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 14/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1525609 | (05) | TN |
6016883 | BLUECROSS BLUESHIELD (01) | TN |
9292410 | AETNA (01) | TN |
P01361606 | RAILROAD MEDICARE (01) | TN |