Healthcare Provider Details

I. General information

NPI: 1487615209
Provider Name (Legal Business Name): JAMES R OTWORTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 27TH ST
PORTSMOUTH OH
45662-2686
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-8231
  • Fax: 710-356-3686
Mailing address:
  • Phone: 740-356-8681
  • Fax: 740-353-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34004394
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC4230
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21422
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: