Provider Demographics
NPI:1215900980
Name:RICKMAN, OTIS B (DO)
Entity type:Individual
Prefix:DR
First Name:OTIS
Middle Name:B
Last Name:RICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4230 HARDING PIKE STE 530
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2094
Mailing Address - Country:US
Mailing Address - Phone:615-222-1270
Mailing Address - Fax:615-222-1275
Practice Address - Street 1:4230 HARDING PIKE STE 530
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2094
Practice Address - Country:US
Practice Address - Phone:615-222-1270
Practice Address - Fax:615-222-1275
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2073207RP1001X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G97391Medicare UPIN