Provider Demographics
NPI:1114253010
Name:OTTE, CARL W (DO)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:W
Last Name:OTTE
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 1:20101 N LAGOS CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-5013
Mailing Address - Country:US
Mailing Address - Phone:623-546-9204
Mailing Address - Fax:
Practice Address - Street 1:20101 N LAGOS CT
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5013
Practice Address - Country:US
Practice Address - Phone:623-546-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1667207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine