Individual
JULIO C OTAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 N BEDELL AVE, DEL RIO, TX 78840-4112
(830) 703-1745
(830) 774-4599
Mailing address
8401 DATAPOINT DR STE 600, P. O. BOX 29441, SAN ANTONIO, TX 78229-5907
(210) 616-7796
(210) 616-7799
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G6083
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356149-15
—
TX
05
—
1356149-16
—
TX
05
—
1356149-17
—
TX
01
—
300136080
RAILROAD MEDICARE
TX
01
—
300136181
RAILROAD MEDICARE
TX
01
—
G6083
TEXAS MEDICAL LICENSE
TX
Enumeration date
10/13/2006
Last updated
05/31/2016
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