Healthcare Provider Details

I. General information

NPI: 1871504662
Provider Name (Legal Business Name): RANDAL A OTTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7979 WURZBACH RD
SAN ANTONIO TX
78229-4427
US

IV. Provider business mailing address

7703 FLOYD CURL DR MC 7977
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-1500
  • Fax: 210-450-9970
Mailing address:
  • Phone: 210-257-1400
  • Fax: 210-257-1428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberH6911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: