Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME78987 | FL |
NPI | 1043207657 |
---|---|
Provider Name | Dr. Christopher Potter |
First Address | Jacksonville, FL 32203-1113 |
Second Address | Jacksonville Beach, FL 32250-3206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001841300 | (05) | FL |
G43511 | (02) | FL |