MEDICARE: F. OTIS STEPHEN M.D.

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	207RG0100X	Gastroenterology Physician	A76669	CA

General Provider Information

NPI Number	:	1780615906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	F. OTIS STEPHEN M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 UCLA MEDICAL PLZ STE 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-6999
Country	:	US
Telephone Number	:	310-423-3870
Fax Number	:	310-423-0429

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/06/2025

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Directions to “ F. OTIS STEPHEN M.D.” Practice Location

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