Individual
DR. STEPHANIE A OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
621 S NEW BALLAS RD, SUITE 63B, SAINT LOUIS, MO 63141-8232
(314) 983-4700
(314) 692-9862
Mailing address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
106730
MO
207XP3100X
Pediatric Orthopaedic Surgery Physician
Primary
106730
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0900169
UNITED HEALTHCARE
MO
01
—
1598506001
CIGNA
MO
01
—
200030003
RAILROAD MEDICARE
MO
05
—
207688508
—
MO
01
—
24774
BLUE CROSS BLUE SHIELD
MO
01
—
256445
HEALTHLINK
MO
01
—
4534390
AETNA
MO
01
—
83380V3223
GROUP HEALTHPLAN
MO
Enumeration date
06/24/2006
Last updated
08/28/2013
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