Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OT020894 | PA |
NPI | 1003483702 |
---|---|
Provider Name | Matthew Alan Potts |
First Address | Erie, PA 16509-2695 |
Second Address | Erie, PA 16509-2695 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |