Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 05-33528 | KS |
N | 208200000X | Surgeon | 05-33528 | KS |
N | 208600000X | Surgeon | 05-33528 | KS |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 05-33528 | KS |
N | 208D00000X | General Practice Physician | 05-33528 | KS |
NPI | 1003920877 |
---|---|
Provider Name | Mr. Kirk David Potter |
First Address | Hays, KS 67601 |
Second Address | Hays, KS 67601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 10/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1613811 | HIGHMARK BLUE SHIELD (01) | PA |
1613811 | PERSONAL CHOICE (01) | PA |
200582300I | (05) | KS |
2290955000 | KEYSTONE IBC (01) | PA |
34935 | HEALTH PARTNERS (01) | PA |
I06540 | (02) | PA |
P00189173 | RAILROAD MEDICARE (01) | PA |