Healthcare Provider Details

I. General information

NPI: 1740348747
Provider Name (Legal Business Name): RALPH DAVID POTTER NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 E MORGAN TRL SUITE #5A
SCOTTSDALE AZ
85258-1232
US

IV. Provider business mailing address

8040 E MORGAN TRL SUITE #5A
SCOTTSDALE AZ
85258-1232
US

V. Phone/Fax

Practice location:
  • Phone: 480-603-9273
  • Fax:
Mailing address:
  • Phone: 480-603-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number04-800
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: