Individual
RANDOLPH OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2202 S CEDAR ST STE 200, TACOMA, WA 98405-2318
(253) 383-1099
(253) 383-3919
Mailing address
3402 S 18TH ST, TACOMA, WA 98405-1903
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
00027380
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8125395
—
WA
Enumeration date
11/17/2006
Last updated
07/08/2007
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