Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 5083197-1205 | UT |
NPI | 1003816927 |
---|---|
Provider Name | Richard Ott |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | St George, UT 84770-3949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 10/05/2011 |