Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | N1421 | TX |
NPI | 1376595298 |
---|---|
Provider Name | Steve Roe Potter |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 05/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34149 | (02) | CA |