Healthcare Provider Details

I. General information

NPI: 1942240254
Provider Name (Legal Business Name): RICHARD LEMUEL OTTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MOBILE INFIRMARY CIR SUITE 201
MOBILE AL
36607-3514
US

IV. Provider business mailing address

3 MOBILE INFIRMARY CIR SUITE 201
MOBILE AL
36607-3514
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-1887
  • Fax: 251-433-1929
Mailing address:
  • Phone: 251-433-1887
  • Fax: 251-433-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00007709
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7709
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: