Provider Demographics
NPI:1528255262
Name:OTTO, STEVEN R (MD, JD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:OTTO
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E. GRAND CANYON DR.
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249
Mailing Address - Country:US
Mailing Address - Phone:480-275-8741
Mailing Address - Fax:602-926-8987
Practice Address - Street 1:1555 E. GRAND CANYON DR.
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249
Practice Address - Country:US
Practice Address - Phone:480-275-8741
Practice Address - Fax:602-926-8987
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13323209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine