MEDICARE: OTT LE MD

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	2085R0202X	Diagnostic Radiology Physician	M3293	TX

General Provider Information

NPI Number	:	1720139231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTT LE MD

Provider Business Mailing Address
First Line	:	6424 CENTRAL CITY BLVD
Second Line	:	# 428
City	:	GALVESTON
State	:	TX
Zip	:	77551-2195
Country	:	US
Telephone Number	:	832-768-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	6424 CENTRAL CITY BLVD
Second Line	:	# 428
City	:	GALVESTON
State	:	TX
Zip	:	77551-2195
Country	:	US
Telephone Number	:	832-768-6518
Fax Number	:

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

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	07/08/2007

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