Healthcare Provider Details

I. General information

NPI: 1992770887
Provider Name (Legal Business Name): GREGORY A. POTTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST SUITE 328
WASHINGTON MO
63090-3135
US

IV. Provider business mailing address

851 E 5TH ST SUITE 328
WASHINGTON MO
63090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-1101
  • Fax: 636-239-0250
Mailing address:
  • Phone: 636-239-1101
  • Fax: 636-239-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR7F05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: