Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01068802A | IN |
Y | 207K00000X | Allergist & Immunologist | 44263 | KY |
NPI | 1215924477 |
---|---|
Provider Name | Dr. Hans Frederick Otto |
First Address | Louisville, KY 40223-2992 |
Second Address | Florence, KY 41042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100159850 | (05) | KY |