Healthcare Provider Details

I. General information

NPI: 1942208590
Provider Name (Legal Business Name): IRA BLAINE POTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9879 KY ROUTE 122
MC DOWELL KY
41647-6026
US

IV. Provider business mailing address

9879 KY ROUTE 122
MC DOWELL KY
41647-6026
US

V. Phone/Fax

Practice location:
  • Phone: 606-377-3462
  • Fax: 606-377-3466
Mailing address:
  • Phone: 606-377-3462
  • Fax: 606-377-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: