MEDICARE: MATTHEW BRITTON POTER R.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
1	133V00000X	Registered Dietitian	DT81361	TX

General Provider Information

NPI Number	:	1730615360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BRITTON POTER R.D.

Provider Business Mailing Address
First Line	:	11430 EAST FWY STE 330
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1959
Country	:	US
Telephone Number	:	713-446-3723
Fax Number	:

Provider Business Practice Location Address
First Line	:	11430 EAST FWY STE 330
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-1959
Country	:	US
Telephone Number	:	713-446-3723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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