Provider Demographics
NPI:1356442255
Name:OTT, RICHARD F (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:F
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 1:1440 S OCEAN BLVD
Mailing Address - Street 2:APT 5A
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7346
Mailing Address - Country:US
Mailing Address - Phone:954-788-8527
Mailing Address - Fax:
Practice Address - Street 1:3536 N FEDERAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6264
Practice Address - Country:US
Practice Address - Phone:954-564-2800
Practice Address - Fax:954-568-3033
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33910174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60549Medicare UPIN
93698Medicare ID - Type Unspecified