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General NPI Number Information
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NPI Number | 1083971048
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Entity Type | Individual
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Provider Name | PERRY STEPHEN POTEET M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 10/01/2018
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Provider Practice Location Address
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Address Line | 40 N GRAND AVE STE.101
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City | FORT THOMAS
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State | KY
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Zip | 41075-4107
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Country | US
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Telephone | 937-475-3327
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Fax |
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Provider Business Mailing Address
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Address Line | 40 N GRAND AVE STE 103
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City | FORT THOMAS
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State | KY
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Zip | 41075-1765
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Country | US
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Telephone | 859-781-4900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 01077903A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 390200000
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | TP531
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License Number State | KY
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