Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 13905 | NE |
NPI | 1043583560 |
---|---|
Provider Name | Dr. Virgil V Ottun |
First Address | Sargent, NE 68874-3119 |
Second Address | Sargent, NE 68874-3119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2012 |
Last Update Date | 14/02/2012 |