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NPI Code Detail

MEDICARE: GREGG THOMAS POTTORFF M.D.

MEDICARE: GREGG THOMAS POTTORFF M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianG61064CA
2207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianG61064CA

General Provider Information

NPI Number : 1477520096
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGG THOMAS POTTORFF M.D.
Provider Business Mailing Address
First Line : 19842 LAKE CHABOT RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-4002
Country : US
Telephone Number : 510-886-8844
Fax Number : 510-247-8280
Provider Business Practice Location Address
First Line : 19842 LAKE CHABOT RD
Second Line :
City : CASTRO VALLEY
State : CA
Zip : 94546-4002
Country : US
Telephone Number : 510-886-8844
Fax Number : 510-247-8280
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2006
Last Update Date : 06/07/2012

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Directions to “ GREGG THOMAS POTTORFF M.D.” Practice Location

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