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General NPI Number Information
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NPI Number | 1548234636
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Entity Type | Organization
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Legal Business Name | R OTTO MD PA
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 1209 BENT OAKS CT
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City | DENTON
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State | TX
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Zip | 76210-3300
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Country | US
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Telephone | 940-891-6100
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Fax | 940-891-6110
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Provider Business Mailing Address
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Address Line | 1209 BENT OAKS CT
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City | DENTON
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State | TX
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Zip | 76210-3300
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Country | US
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Telephone | 940-891-6100
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Fax | 940-891-6110
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL JON OTTO
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Credential | MD
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Telephone | 940-891-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | K6206
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License Number State | TX
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