Healthcare Provider Details

I. General information

NPI: 1104117779
Provider Name (Legal Business Name): JOSHUA ROBEY POTOCKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 CAMP ST
NEW ORLEANS LA
70115-2807
US

IV. Provider business mailing address

4437 CAMP ST
NEW ORLEANS LA
70115-2807
US

V. Phone/Fax

Practice location:
  • Phone: 303-999-5763
  • Fax:
Mailing address:
  • Phone: 303-999-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberC146100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number345860
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC146100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: