Individual
TODD M OTSTOT
Active
Individual
TODD M OTSTOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-356
ID
363A00000X
Physician Assistant
PA356
ID
363AM0700X
Medical Physician Assistant
Primary
PA-356
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010035292
BLUE SHIELD
ID
01
—
000010035293
BLUE SHIELD
ID
05
—
806153700
—
ID
01
—
970022197
RAILROAD MEDICARE
ID
01
—
PAA02
BLUE CROSS
ID
01
—
PAAE9
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
10/06/2022
Update your record
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