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General NPI Number Information
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NPI Number | 1497757587
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Entity Type | Individual
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Provider Name | ROY N POTTENGER MD
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Gender | Male
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 6403 COYLE AVE STE 170
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City | CARMICHAEL
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State | CA
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Zip | 95608-0363
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Country | US
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Telephone | 916-965-4000
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Fax | 916-965-4813
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Provider Business Mailing Address
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Address Line | 6403 COYLE AVE STE 170
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City | CARMICHAEL
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State | CA
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Zip | 95608-0363
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Country | US
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Telephone | 916-965-4000
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Fax | 916-965-4813
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | C39298
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License Number State | IN
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