Healthcare Provider Details

I. General information

NPI: 1063510220
Provider Name (Legal Business Name): JANET LYNN OTTO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CHANNING WAY STE 220
IDAHO FALLS ID
83404-7546
US

IV. Provider business mailing address

PO BOX 277381
ATLANTA GA
30384-7381
US

V. Phone/Fax

Practice location:
  • Phone: 208-800-6155
  • Fax: 208-800-6158
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberM-14309
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberM-14309
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: