Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35.127414 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | R6288 | MO |
NPI | 1396839890 |
---|---|
Provider Name | Charles R. Potter |
First Address | Cincinnati, OH 45263-6930 |
Second Address | Lima, OH 45801-3990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 27/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C39944 | (02) |