Provider Demographics
NPI:1346469020
Name:RICHARD A. OTT, MD, INC.
Entity Type:Organization
Organization Name:RICHARD A. OTT, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-774-1102
Mailing Address - Street 1:PO BOX 9036
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-1036
Mailing Address - Country:US
Mailing Address - Phone:714-774-1102
Mailing Address - Fax:949-459-0100
Practice Address - Street 1:1211 W LA PALMA AVE STE 608
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2813
Practice Address - Country:US
Practice Address - Phone:714-774-1102
Practice Address - Fax:949-459-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095360OtherCAL-OPTIMA
CAGR0095360Medicaid
CAW16477Medicare ID - Type UnspecifiedGROUP ID
CAC46596Medicare UPIN