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Individual
DR. ANDREA SHAE OTTO
Active
Individual
DR. ANDREA SHAE OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012013484
MO
207Q00000X
Family Medicine Physician
23567
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012013484
STATE LICENSE
MO
01
—
23567
STATE LICENSE NUMBER
NE
Enumeration date
06/18/2006
Last updated
03/14/2017
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