Individual
LESLEY NICOLOFF OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9155 SW BARNES RD, SUITE 634, PORTLAND, OR 97225-6625
(503) 297-4123
(509) 297-0344
Mailing address
847 NE19TH, SUITE 300, PORTLAND, OR 97232
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD18878
OR
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
MD60636494
WA
207VG0400X
Gynecology Physician
MD18878
OR
207VG0400X
Gynecology Physician
MD60636494
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073122
—
OR
05
—
1699729608
—
WA
05
—
2038459
—
WA
01
—
931237109
TAX ID
OR
01
—
MD18878
LICENSE
OR
Enumeration date
05/22/2006
Last updated
04/27/2016
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