Individual
GARY M OTTERSBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2521 E 15TH ST, CASPER, WY 82609-4126
(307) 472-2293
Mailing address
2521 E 15TH ST, CASPER, WY 82609-4126
(307) 472-2293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA1001
NV
363AM0700X
Medical Physician Assistant
Primary
115
WY
Other
Enumeration date
10/05/2006
Last updated
03/31/2010
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