Healthcare Provider Details

I. General information

NPI: 1083971048
Provider Name (Legal Business Name): PERRY STEPHEN POTEET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N GRAND AVE STE.101
FORT THOMAS KY
41075-4107
US

IV. Provider business mailing address

40 N GRAND AVE STE 103
FORT THOMAS KY
41075-1765
US

V. Phone/Fax

Practice location:
  • Phone: 937-475-3327
  • Fax:
Mailing address:
  • Phone: 859-781-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01077903A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberTP531
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: