Provider Demographics
NPI:1356672273
Name:THEODORE OTEY, M.D., P.A.
Entity Type:Organization
Organization Name:THEODORE OTEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFENBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-522-7086
Mailing Address - Street 1:2510 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-1445
Mailing Address - Country:US
Mailing Address - Phone:713-522-7086
Mailing Address - Fax:713-522-7087
Practice Address - Street 1:2510 BROAD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-1445
Practice Address - Country:US
Practice Address - Phone:713-522-7086
Practice Address - Fax:713-522-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty