Dr. Mallory Otto
Internal Medicine (Geriatric Medicine)

Address: 1600 Sw Archer Rd, Uf Health Shands, Gainesville, FL 32610-2610
Phone: 3522739212

Dr. Mallory Otto (NPI# 1124317532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1124317532
Entity Type Individual
Full Name Dr. Mallory Otto
Credential M.D.
Gender Female
Practice Address 1600 Sw Archer Rd
Uf Health Shands
Gainesville
FL 32610-2610
Practice Telephone 3522739212
Practice Fax Number 3522657228
Mailing Address Po Box 112610
Uf Health Shands Dept of Aging
Gainesville
FL 32611
Sole Proprietor No, this individual is not a Sole Proprietor
Enumeration Date 2011-04-06
Last Update Date 2015-08-18

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 207RG0300X Internal Medicine · Geriatric Medicine Allopathic & Osteopathic Physicians ME123300 FL
No 390200000X Student in an Organized Health Care Education/Training Program Student, Health Care

Other Provider Identifier

State Identifier Issuer Type Code
FL 014883700 MEDICAID

Physician Overview

NPI 1124317532
PAC ID by PECOS 0941514384
Professional Enrollment ID I20150729010195
Full Name Mallory B Otto
Organization Legal Name FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Gender F
Graduation Year 2011
Primary Specialty GERIATRIC MEDICINE
Group Practice PAC ID 0345146254
Number of Group Practice Members 1073
Accepts Medicare Assignment Y
Report Quality Measures Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
100113 UF HEALTH SHANDS HOSPITAL

Office Location

Street Address 1600 SW ARCHER RD
UF HEALTH SHANDS
City GAINESVILLE
State FL
Zip Code 32610-2610

Providers in the same location

NPI Name Taxonomy Address Enumeration
1336243906 Sarah Grace Fitzpatrick Dentist 1600 Sw Archer Rd, Rm D8-6, Gainesville, FL 32610-3003 2006-09-12
1811468028 Daylee Sue Bewak Physician Assistant 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-12-16
1679043533 Kimberly Erickson Case Manager/Care Coordinator 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-12-04
1386114403 Beverly Frazee Mcdaniel Nurse Practitioner 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-12-01
1043787732 Kristen Drake Dietitian, Registered 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-10-31
1033686852 Jenna Nicole Seckar Dietitian, Registered 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-10-30
1245714302 Regina Lynn Sledge Nurse Practitioner 1600 Sw Archer Rd, Gainesville, FL 32610-0108 2018-09-24
1134601172 Joel Patrick Shoemaker Physician Assistant 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2018-09-06
1891275855 Bruce Burdine Anesthesiologist Assistant 1600 Sw Archer Rd, Gainesville, FL 32610-0254 2018-08-20
1265912562 Yu Wu Nurse Practitioner 1600 Sw Archer Rd, Gainesville, FL 32610-0251 2018-08-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1609361906 Angela Wong Dentist 1395 Center Dr Rm D1-11, Gainesville, FL 32610 2018-06-28
1104310549 Brandon Lucke-wold Neurological Surgery 1149 S Newell Dr Deapartment of Neurosurgery Bldg #59, Gainesville, FL 32610 2018-06-19
1619465754 Carlos Eduardo Vervloet Sollero Student in an Organized Health Care Education/Training Program 1149 Newell Drive, University of Florida, Department of Neurology, Gainesville, FL 32610 2018-04-24
1447619937 Wajdi Mohammed Dentist 1395 Center Dr., D8-6, Gainesville, FL 32610 2016-02-12
1972981512 David Shin Student in an Organized Health Care Education/Training Program 1600 Sw Archer Road, Fl 1, Rm 1097, Gainesville, FL 32610 2015-05-15
1669887485 Alejandro Jose Delgado Dentist 1395 Center Drive, University of Florida, College of Dentistry, Gainsville, FL 32610 2014-07-01
1194167296 Zain Shahid Student in an Organized Health Care Education/Training Program 1600 Sw Archer Rd # Ng-45, Gainesville, FL 32610 2013-07-18
1104265909 Nakia Wilson Psychiatry & Neurology 100 Newell Dr Ste L3-100, Gainesville, FL 32610 2013-06-14
1538505409 Mathew Leonard Romankowski Internal Medicine 1600 Sw Archer Rd # 100254, Gainesville, FL 32610 2013-05-17
1598008153 Matthew Christian Hansen Dentist 1395 Center Dr D8-6, Gainesville, FL 32610 2013-04-02
Find all providers in zip 32610

Taxonomy Information

Taxonomy Code 207RG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Geriatric Medicine

Taxonomy Definition

An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1053677260 So Dam Kim Internal Medicine 1600 Sw Archer Rd # 112610, Gainesville, FL 32610-3411 2012-04-02
1821361577 Senior Care Office, LLC Internal Medicine 2020 Beverly Road, Gainesville, GA 30501-2037 2012-02-10
1689816316 Geriatrics and Internal Medicine Practices Pa Internal Medicine 3921 Sw 34th St, Suite 201, Gainesville, FL 32608-6560 2009-03-26
1770510620 Rafael Alberto Cott Jr. Internal Medicine 2205 Nw 40th Ter, Ste B, Gainesville, FL 32605-3500 2006-06-27
1477500122 Swati Gaur Internal Medicine 2020 Beverly Rd, Gainesville, GA 30501-2037 2006-05-28
1679836456 Jacobo Hincapie Echeverri Internal Medicine 1505 Fort Clarke Blvd, Bldg 6 Apt 307, Gainesville, FL 32606-7182 2012-06-18
1750649018 Susan Gail Nayfield Internal Medicine 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2012-04-24
1104989789 Ann T Weber Internal Medicine 3750 Nw 83rd St, Gainesville, FL 32606-5603 2006-12-18
1588779110 Prabir Banik Internal Medicine 2205 Nw 40th Ter, Suite B, Gainesville, FL 32605-3500 2006-08-21
1689608705 Alan Arthur Goldblatt Internal Medicine 2205 Nw 40th Ter, Ste B, Gainesville, FL 32605-3500 2006-07-11
Find all providers in GAINESVILLE

Competitor

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City GAINESVILLE
Zip Code 32610

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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