Individual
DR. ANDREA SHAE OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1001 S KIRKWOOD RD, STE 300, SAINT LOUIS, MO 63122-7254
(314) 543-5943
(314) 543-5953
Mailing address
1001 S KIRKWOOD RD, STE 300, SAINT LOUIS, MO 63122-7254
(314) 543-5943
(314) 543-5953
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012013484
MO
207Q00000X
Family Medicine Physician
23567
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012013484
STATE LICENSE
MO
01
—
23567
STATE LICENSE NUMBER
NE
Enumeration date
06/18/2006
Last updated
03/14/2017
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