Provider Demographics
NPI:1568439156
Name:OTTO, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:OTTO
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 1:629 COYOTE CV
Mailing Address - Street 2:A
Mailing Address - City:DUGWAY
Mailing Address - State:UT
Mailing Address - Zip Code:84022-1079
Mailing Address - Country:US
Mailing Address - Phone:435-831-2222
Mailing Address - Fax:
Practice Address - Street 1:629 COYOTE CV
Practice Address - Street 2:A
Practice Address - City:DUGWAY
Practice Address - State:UT
Practice Address - Zip Code:84022-1079
Practice Address - Country:US
Practice Address - Phone:435-831-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056256A2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine