Provider Demographics
NPI:1063510220
Name:OTTO, JANET LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:435-251-2500
Mailing Address - Fax:435-656-4907
Practice Address - Street 1:1380 E MEDICAL CENTER DR
Practice Address - Street 2:STE 1500
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:435-251-2500
Practice Address - Fax:435-656-4907
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8480207RC0001X
AZ46598207RC0001X
UT186150-8017207RC0000X
UT186150-1205207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000016981OtherBCBS PIN
AZ719212Medicaid
WY113637200OtherMDCD PIN
MT314480OtherBCBS PIN
MT0011832OtherMDCD PIN
MT000016981OtherBCBS PIN
WY113637200OtherMDCD PIN
MT060052298Medicare PIN
MTG77924Medicare UPIN
MT000080957Medicare PIN
AZ719212Medicaid