Individual
PATRICK THOMAS OTTUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M D F A A D
Contact information
Practice address
1955 22ND AVE, VERO BEACH, FL 32960-3083
(772) 299-0085
(772) 978-4193
Mailing address
1955 22ND AVE, VERO BEACH, FL 32960-3083
(772) 299-0085
(772) 978-4193
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME62353
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070015813
RR MEDICARE
FL
01
—
18397
BLUE CROSS
FL
01
—
9614490
GHI
FL
Enumeration date
11/29/2005
Last updated
10/11/2007
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