Healthcare Provider Details

I. General information

NPI: 1891700209
Provider Name (Legal Business Name): OTTO HANS KIEFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 PLAINVIEW ST SUITE C-9
PASADENA TX
77504-1989
US

IV. Provider business mailing address

3325 PLAINVIEW ST SUITE C-9
PASADENA TX
77504-1989
US

V. Phone/Fax

Practice location:
  • Phone: 713-830-2996
  • Fax: 713-830-2998
Mailing address:
  • Phone: 713-830-2996
  • Fax: 713-830-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK1505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: