Provider Demographics
NPI:1891700209
Name:KIEFFER, OTTO HANS (MD)
Entity Type:Individual
Prefix:DR
First Name:OTTO
Middle Name:HANS
Last Name:KIEFFER
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 1:3325 PLAINVIEW ST
Mailing Address - Street 2:SUITE C-9
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1989
Mailing Address - Country:US
Mailing Address - Phone:713-830-2996
Mailing Address - Fax:713-830-2998
Practice Address - Street 1:3325 PLAINVIEW ST
Practice Address - Street 2:SUITE C-9
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1989
Practice Address - Country:US
Practice Address - Phone:713-830-2996
Practice Address - Fax:713-830-2998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092239503Medicaid
TXG30820Medicare UPIN