MEDICARE: RICHARD DANIEL POTTS MD PLLC

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
1	207Q00000X	Family Medicine Physician	ME99225	FL

General Provider Information

NPI Number	:	1689994303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD DANIEL POTTS MD PLLC

Provider Business Mailing Address
First Line	:	125 OCEAN SHORE BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-5734
Country	:	US
Telephone Number	:	386-506-9994
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 N BEACH ST STE C
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5656
Country	:	US
Telephone Number	:	386-506-9994
Fax Number	:	386-281-5870

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD DANIEL POTTS
Credential	:	MD
Telephone Number	:	386-509-9994

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	07/21/2022

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