Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 106730 | MO |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 106730 | MO |
NPI | 1841226487 |
---|---|
Provider Name | Dr. Stephanie A Otis |
First Address | Saint Louis, MO 63128-2786 |
Second Address | Saint Louis, MO 63141-8232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 28/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0900169 | UNITED HEALTHCARE (01) | MO |
1598506001 | CIGNA (01) | MO |
200030003 | RAILROAD MEDICARE (01) | MO |
207688508 | (05) | MO |
24774 | BLUE CROSS BLUE SHIELD (01) | MO |
256445 | HEALTHLINK (01) | MO |
4534390 | AETNA (01) | MO |
83380V3223 | GROUP HEALTHPLAN (01) | MO |
F88384 | (02) |