MEDICARE: DR. MATTHEW HC OTTEN DO

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	207Q00000X	Family Medicine Physician	SL0386	NV

General Provider Information

NPI Number	:	1528238144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW HC OTTEN DO

Provider Business Mailing Address
First Line	:	PO BOX 6255
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89041-6255
Country	:	US
Telephone Number	:	702-984-6587
Fax Number	:	702-463-2894

Provider Business Practice Location Address
First Line	:	5741 S FORT APACHE RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5622
Country	:	US
Telephone Number	:	29-846-5877
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	08/08/2019

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