Organization
LESLEY NICOLOFF OTTO MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY N OTTO MD (PHYSICIAN)
(503) 297-4123
Entity
Organization
Contact information
Practice address
9155 SW BARNES RD, SUITE 634, PORTLAND, OR 97225-6633
(503) 297-4123
(503) 297-0344
Mailing address
9155 SW BARNES RD, SUITE 634, PORTLAND, OR 97225-6633
(503) 297-4123
(503) 297-0344
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
MD18878
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073122
—
OR
01
—
MD18878
MEDICAL LICENSE
OR
Enumeration date
11/15/2007
Last updated
12/20/2010
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