Organization
OTTEY BONE AND JOINT ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERON C OTTEY M.D. (OWNER)
(904) 368-0641
Entity
Organization
Contact information
Practice address
417 W CALL ST, STARKE, FL 32091-3115
(904) 368-0641
(904) 368-0643
Mailing address
417 W CALL ST, STARKE, FL 32091-3115
(904) 368-0641
(904) 368-0643
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME112364
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004663600
—
FL
Enumeration date
03/20/2012
Last updated
09/23/2016
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