Provider Demographics
NPI:1902981228
Name:BOTERO, SOFFY D (MD)
Entity type:Individual
Prefix:DR
First Name:SOFFY
Middle Name:D
Last Name:BOTERO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3712 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114
Mailing Address - Country:US
Mailing Address - Phone:504-366-1566
Mailing Address - Fax:504-366-1575
Practice Address - Street 1:3712 MACARTHUR BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114
Practice Address - Country:US
Practice Address - Phone:504-366-1566
Practice Address - Fax:504-366-1575
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA012139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1137120Medicaid
B60295Medicare UPIN
5J082Medicare ID - Type Unspecified