Individual
DR. JOSEPH BOTTALICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
420 E 6TH ST, SUITE 202, ODESSA, TX 79761-4529
(432) 582-8757
(432) 582-8928
Mailing address
PO BOX 4123, ODESSA, TX 79760-4123
(432) 582-2277
(432) 333-2802
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MB04176800
NJ
207V00000X
Obstetrics & Gynecology Physician
OS005732L
PA
207VM0101X
Maternal & Fetal Medicine Physician
MB04176800
NJ
207VM0101X
Maternal & Fetal Medicine Physician
Primary
P1969
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2099101
—
NJ
05
—
8895NO
—
TX
Enumeration date
01/27/2006
Last updated
01/05/2016
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