Individual
NANCY RUTH OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8715 VILLAGE DR, SUITE 120, SAN ANTONIO, TX 78217-5405
(210) 477-5151
(210) 477-5152
Mailing address
6704 RANDOLPH BLVD, LIVE OAK, TX 78233-4222
(210) 477-5151
(210) 477-5152
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
H3721
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01396263
RAILROAD MEDICARE
TX
Enumeration date
01/25/2007
Last updated
01/25/2022
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