Healthcare Provider Details

I. General information

NPI: 1003084682
Provider Name (Legal Business Name): SHERRY PATRICIA POTTGEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21807 N SCOTTSDALE RD
SCOTTSDALE AZ
85255-7439
US

IV. Provider business mailing address

10498 E MORNING STAR DR
SCOTTSDALE AZ
85255-8658
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-8488
  • Fax: 480-425-8498
Mailing address:
  • Phone: 480-350-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38003
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: