Healthcare Provider Details

I. General information

NPI: 1346334562
Provider Name (Legal Business Name): ROBERT SCOTT POTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16871 CIMARRON PASS
NOBLESVILLE IN
46060-4292
US

IV. Provider business mailing address

16871 CIMARRON PASS
NOBLESVILLE IN
46060-4292
US

V. Phone/Fax

Practice location:
  • Phone: 317-845-6256
  • Fax:
Mailing address:
  • Phone: 317-845-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01035268
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01035268A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01035268
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: