Provider Demographics
NPI:1477690766
Name:OTTO, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:OTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1204 N MOUND ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4027
Mailing Address - Country:US
Mailing Address - Phone:936-568-8425
Mailing Address - Fax:
Practice Address - Street 1:1002 N MOUND ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4437
Practice Address - Country:US
Practice Address - Phone:936-560-3800
Practice Address - Fax:936-205-4359
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF20911Medicare UPIN