Provider Demographics
NPI:1689848061
Name:OTTO, LAURIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 PRESTON RD, STE 350, #224
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7471
Mailing Address - Country:US
Mailing Address - Phone:972-900-0738
Mailing Address - Fax:972-378-3970
Practice Address - Street 1:3308 PRESTON RD, STE 350, #224
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7471
Practice Address - Country:US
Practice Address - Phone:972-900-0738
Practice Address - Fax:972-378-3970
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1749207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine