Healthcare Provider Details

I. General information

NPI: 1053328575
Provider Name (Legal Business Name): JAMES L POTH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 CARBONERA DR
SANTA CRUZ CA
95060-1608
US

IV. Provider business mailing address

419 CARBONERA DR
SANTA CRUZ CA
95060-1608
US

V. Phone/Fax

Practice location:
  • Phone: 831-426-0607
  • Fax: 831-427-1525
Mailing address:
  • Phone: 831-426-0607
  • Fax: 831-427-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG142100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: