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1952308967

NPI Code Detail

MEDICARE: ERIC DONALD OTTENBACHER PA

MEDICARE: ERIC DONALD OTTENBACHER PA

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	363A00000X	Physician Assistant	PA10004156	WA
2	363A00000X	Physician Assistant	PA797	WY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	970022268	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	149048	OTHER	WA	LABOR & IND.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8929945	OTHER	WA	CRIME VICTIMS

General Provider Information

NPI Number	:	1952308967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC DONALD OTTENBACHER PA

Provider Business Mailing Address
First Line	:	2030 BLUEGRASS CIR
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-7328
Country	:	US
Telephone Number	:	317-635-3500
Fax Number	:	360-575-6749

Provider Business Practice Location Address
First Line	:	2030 BLUEGRASS CIR
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-7328
Country	:	US
Telephone Number	:	317-635-3500
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/31/2025

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Directions to “ ERIC DONALD OTTENBACHER PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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