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General NPI Number Information
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NPI Number | 1386627867
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Entity Type | Individual
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Provider Name | PATRICK THOMAS OTTUSO M D F A A D
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 1955 22ND AVE
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City | VERO BEACH
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State | FL
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Zip | 32960-3083
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Country | US
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Telephone | 772-299-0085
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Fax | 772-978-4193
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Provider Business Mailing Address
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Address Line | 1955 22ND AVE
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City | VERO BEACH
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State | FL
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Zip | 32960-3083
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Country | US
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Telephone | 772-299-0085
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Fax | 772-978-4193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME62353
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License Number State | FL
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