Healthcare Provider Details

I. General information

NPI: 1942260864
Provider Name (Legal Business Name): RICHARD A POTTS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NORTH WEST ST
ODON IN
47562
US

IV. Provider business mailing address

PO BOX 760 1314 EAST WALNUT ST
WASHINGTON IN
47501
US

V. Phone/Fax

Practice location:
  • Phone: 812-636-7300
  • Fax: 812-636-8204
Mailing address:
  • Phone: 812-254-7310
  • Fax: 812-254-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000896A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: