Individual
DR. IGOR OTAHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 BARNES JEWISH HOSPITAL PLZ, SAINT LOUIS, MO 63110-1003
(314) 362-6973
(314) 362-1185
Mailing address
PO BOX 8221, 7425 FORSYTH, SAINT LOUIS, MO 63156-8221
(314) 935-0770
(314) 935-0575
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2005002896
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
336
MO-BLUE SHIELD
—
Enumeration date
07/14/2006
Last updated
07/08/2007
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