Provider Demographics
NPI:1093802530
Name:OTT, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:OTT
Suffix:
Gender:M
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 20345
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0345
Mailing Address - Country:US
Mailing Address - Phone:832-355-4900
Mailing Address - Fax:
Practice Address - Street 1:1101 BATES AVE
Practice Address - Street 2:P115
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2607
Practice Address - Country:US
Practice Address - Phone:832-355-4900
Practice Address - Fax:832-355-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9598208G00000X, 2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX780000003OtherRR MEDICARE
TX83M966Medicare PIN