Provider Demographics
NPI:1194874834
Name:RICHARD F OTT MD PA
Entity type:Organization
Organization Name:RICHARD F OTT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-564-2800
Mailing Address - Street 1:3536 N FEDERAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6264
Mailing Address - Country:US
Mailing Address - Phone:954-564-2800
Mailing Address - Fax:954-568-3003
Practice Address - Street 1:3536 N FEDERAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6264
Practice Address - Country:US
Practice Address - Phone:954-564-2800
Practice Address - Fax:954-568-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO33910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60549Medicare UPIN
FL93698Medicare ID - Type Unspecified