Provider Demographics
NPI:1396857801
Name:ALBUSCHAT, OTTO RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:OTTO
Middle Name:RUSSELL
Last Name:ALBUSCHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-374-6051
Mailing Address - Fax:352-374-6154
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-374-6051
Practice Address - Fax:352-374-6154
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME46058207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041850100Medicaid
FL31175Medicare ID - Type Unspecified
FL041850100Medicaid