Provider Demographics
NPI:1033187075
Name:BOTTAR, PETER (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BOTTAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OAK KNOLL DR.
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2198
Mailing Address - Country:US
Mailing Address - Phone:330-534-9711
Mailing Address - Fax:330-534-0502
Practice Address - Street 1:50 OAK KNOLL DR.
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2198
Practice Address - Country:US
Practice Address - Phone:330-534-9711
Practice Address - Fax:330-534-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine