Provider Demographics
NPI:1720139231
Name:LE, OTT (MD)
Entity Type:Individual
Prefix:
First Name:OTT
Middle Name:
Last Name:LE
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 1:6424 CENTRAL CITY BLVD
Mailing Address - Street 2:# 428
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-2195
Mailing Address - Country:US
Mailing Address - Phone:832-768-6518
Mailing Address - Fax:
Practice Address - Street 1:6424 CENTRAL CITY BLVD
Practice Address - Street 2:# 428
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2195
Practice Address - Country:US
Practice Address - Phone:832-768-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM32932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology