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General NPI Number Information
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NPI Number | 1295739050
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Entity Type | Individual
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Provider Name | DARYL K. POTTER D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4612 OUTER LOOP
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City | LOUISVILLE
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State | KY
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Zip | 40219-3971
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Country | US
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Telephone | 502-968-2233
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Fax | 502-968-2283
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Provider Business Mailing Address
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Address Line | 619 ASHBOURNE DR
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City | SHELBYVILLE
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State | KY
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Zip | 40065-7393
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Country | US
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Telephone | 502-633-7649
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000271
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License Number State | KY
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