Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 01052675 | IN |
Y | 207RH0003X | Hematology & Oncology | 49214 | MN |
NPI | 1073579504 |
---|---|
Provider Name | David A Potter |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-0341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200295760 | (05) | IN |
F97411 | (02) | IN |