Healthcare Provider Details

I. General information

NPI: 1558476952
Provider Name (Legal Business Name): PAUL D. OTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MOORE AVE
CLAREMORE OK
74017-5047
US

IV. Provider business mailing address

2504 W DRIFTWOOD DR
CLAREMORE OK
74017-4822
US

V. Phone/Fax

Practice location:
  • Phone: 918-342-6200
  • Fax: 918-342-6598
Mailing address:
  • Phone: 918-283-8045
  • Fax: 918-283-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1958
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: