Individual
DR. OTTO LOUIS-JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3022 WILLIAMS DR, SUITE 301, FAIRFAX, VA 22031-4600
(703) 698-1775
(703) 641-8427
Mailing address
3022 WILLIAMS DR, SUITE 301, FAIRFAX, VA 22031-4600
(703) 698-1775
(703) 641-8427
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
0101233886
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6738052
—
VA
Enumeration date
02/23/2006
Last updated
03/25/2016
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