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General NPI Number Information
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NPI Number | 1477690766
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Entity Type | Individual
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Provider Name | JAMES M OTTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1002 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4437
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Country | US
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Telephone | 936-560-3800
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Fax | 936-205-4359
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Provider Business Mailing Address
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Address Line | 1204 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4027
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Country | US
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Telephone | 936-568-8425
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J0173
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License Number State | TX
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