Provider Demographics
NPI:1437268133
Name:OTTO, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:OTTO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:403 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4717
Mailing Address - Country:US
Mailing Address - Phone:352-726-3646
Mailing Address - Fax:352-726-0079
Practice Address - Street 1:403 W HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4717
Practice Address - Country:US
Practice Address - Phone:352-726-3646
Practice Address - Fax:352-726-0079
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME107897208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014537500Medicaid
FL014537500Medicaid