Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | H6920 | TX |
NPI | 1316961402 |
---|---|
Provider Name | Dr. Allen R Potter |
First Address | San Antonio, TX 78229-5907 |
Second Address | San Antonio, TX 78229-5907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131701805 | (05) | TX |
131701807 | (05) | TX |
134962307 | (05) | TX |
89X602 | BCBS (01) | TX |