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General NPI Number Information
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NPI Number | 1821208075
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Entity Type | Individual
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Provider Name | JASON R POTEET MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 7100 OAKMONT BLVD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76132-3908
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Country | US
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Telephone | 866-367-8768
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Fax | 817-541-9540
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Provider Business Mailing Address
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Address Line | 5001 S COOPER ST STE 201
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City | ARLINGTON
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State | TX
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Zip | 76017-5993
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Country | US
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Telephone | 866-367-8768
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Fax | 817-541-9555
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | N9115
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License Number State | TX
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