Individual
PATRICIA SUE OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1049 EDGEWATER ST NW # 150, SALEM, OR 97304-4046
(503) 814-4400
(503) 814-4414
Mailing address
1049 EDGEWATER ST NW STE 150, SALEM, OR 97304-4046
(503) 814-4400
(503) 814-4414
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
23396
NE
207Q00000X
Family Medicine Physician
Primary
MD27752
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278841
—
OR
01
—
P000635156
OREGON RAILROAD PROVIDER NUMBER
OR
01
—
R138862
MEDICARE PROVIDER NUMBER
OR
Enumeration date
06/25/2006
Last updated
02/04/2022
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