Individual
CAROL L OTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
0836 SW CURRY ST UNIT 1400, PORTLAND, OR 97239-4529
(310) 704-9796
Mailing address
0836 SW CURRY ST UNIT 1400, PORTLAND, OR 97239-4529
(310) 704-9796
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
G39461
CA
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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