Individual
ERIC DONALD OTTENBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2030 BLUEGRASS CIR, CHEYENNE, WY 82009-7328
(317) 635-3500
Mailing address
2030 BLUEGRASS CIR, CHEYENNE, WY 82009-7328
(317) 635-3500
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA10004156
WA
363A00000X
Physician Assistant
Primary
PA797
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149048
LABOR & IND.
WA
05
—
8330938
—
WA
01
—
8929945
CRIME VICTIMS
WA
01
—
970022268
RR MEDICARE
—
Enumeration date
07/05/2005
Last updated
07/31/2025
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