Otstot, Todd M

Otstot, Todd M is an individual health care provider with primary practice located at 206 E Elm St , Caldwell ID 83605-4815. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Otstot, Todd M can be contacted via phone (208) 459-4511.

Contact Information

Primary practice address
206 E Elm St Caldwell ID 83605-4815
Phone: (208) 459-4511
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA-356 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA356 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA-356 Idaho

Profile Details

NPI number 1275523276
LBN Legal business name Otstot, Todd M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2005
Last updated Oct 6th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275523276 NPPES
Idaho Other 000010035293 BLUE SHIELD
Idaho Other 970022197 BLUE SHIELD
Idaho MEDICAID 806153700 BLUE SHIELD
Idaho Other 000010035292 BLUE SHIELD
Idaho Other PAA02 BLUE SHIELD
Idaho Other PAAE9 BLUE SHIELD

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