Provider Demographics
NPI:1295850436
Name:OTHEE, MANDEEP SINGH (MD)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:SINGH
Last Name:OTHEE
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 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-3774
Mailing Address - Fax:432-640-4774
Practice Address - Street 1:540 W 5TH ST STE 340
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5036
Practice Address - Country:US
Practice Address - Phone:432-640-3774
Practice Address - Fax:432-640-4774
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3560208100000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305901601Medicaid
TX305901601Medicaid