Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD00031791 | WA |
NPI | 1063425890 |
---|---|
Provider Name | Henry O Otero |
First Address | Seattle, WA 98101-1873 |
Second Address | Seattle, WA 98101-2756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 09/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0039582 | LABOR & INDUSTRY (01) | WA |
5531OT | BLUE SHIELD (01) | WA |
8211997 | (05) | WA |
F49193 | (02) | |
MD4490W | ALASKA MEDICAID (01) | WA |
US1017896 | AETNA/USHC SPECIALIST (01) | WA |