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General NPI Number Information
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NPI Number | 1871550780
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Entity Type | Individual
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Provider Name | DERON C. K. OTTEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 115 E 19TH ST
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City | ROSWELL
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State | NM
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Zip | 88201-5110
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Country | US
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Telephone | 575-622-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 115 E 19TH ST
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City | ROSWELL
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State | NM
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Zip | 88201-5110
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Country | US
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Telephone | 575-622-7600
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD2024-1070
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME112364
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License Number State | FL
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