Provider Demographics
NPI:1073172433
Name:OTCHERE, ELAINE (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:OTCHERE
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 1:4401 W GATE BLVD UNIT 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1477
Mailing Address - Country:US
Mailing Address - Phone:512-815-2559
Mailing Address - Fax:512-318-2538
Practice Address - Street 1:4401 W GATE BLVD UNIT 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1477
Practice Address - Country:US
Practice Address - Phone:512-815-2559
Practice Address - Fax:512-318-2538
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2200207N00000X, 207ND0101X
NC259661207N00000X
IAR-12787207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty