MEDICARE: DR. GARY D OTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD070063L	PA
2	207V00000X	Obstetrics & Gynecology Physician	D0081156	MD
3	207V00000X	Obstetrics & Gynecology Physician	152227	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124035688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY D OTT M.D.

Provider Business Mailing Address
First Line	:	7230 MEDICAL CENTER DR STE 204
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4005
Country	:	US
Telephone Number	:	818-346-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 MEDICAL CENTER DR STE 204
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91307-4005
Country	:	US
Telephone Number	:	818-346-5000
Fax Number	:	818-346-4855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/09/2019

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