Provider Demographics
NPI:1235154535
Name:OTIS, JOHN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:OTIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1679 E MAIN ST
Mailing Address - Street 2:205
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5212
Mailing Address - Country:US
Mailing Address - Phone:619-579-8745
Mailing Address - Fax:619-457-2194
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:250
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-457-2180
Practice Address - Fax:858-457-2194
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-09-03
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Provider Licenses
StateLicense IDTaxonomies
CAG285062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91136Medicare UPIN