MEDICARE: THEODORE OTEY, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	J1343	TX

General Provider Information

NPI Number	:	1356672273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEODORE OTEY, M.D., P.A.

Provider Business Mailing Address
First Line	:	2510 BROAD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-1445
Country	:	US
Telephone Number	:	713-522-7086
Fax Number	:	713-522-7087

Provider Business Practice Location Address
First Line	:	2510 BROAD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-1445
Country	:	US
Telephone Number	:	713-522-7086
Fax Number	:	713-522-7087

Authorized Official
Title or Position	:	PA
Name	:	LARA OFFENBURGER
Credential	:
Telephone Number	:	713-522-7086

Provider Enumeration Date	:	01/15/2010
Last Update Date	:	01/15/2010

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