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General NPI Number Information
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NPI Number | 1235855784
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Entity Type | Organization
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Legal Business Name | OTT MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 3900 BOWSER AVE
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 623-210-6504
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Fax |
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Provider Business Mailing Address
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Address Line | 3824 CEDAR SPRINGS RD STE 421
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City | DALLAS
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State | TX
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Zip | 75219-4136
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | NATHANIEL OTT
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Credential | MD
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Telephone | 623-210-6504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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