Individual
DUSTIN J OTTERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
810 FAIRGROVE CHURCH RD, HICKORY, NC 28602-9617
(828) 326-3000
Mailing address
PO BOX 643403, CINCINNATI, OH 45264-0001
(800) 299-4564
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0001-02621
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8994
MEDCOST
—
01
—
P00261502
RAILROAD
—
Enumeration date
06/04/2006
Last updated
05/29/2013
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