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General NPI Number Information
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NPI Number | 1831355643
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Entity Type | Individual
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Provider Name | KEVIN WAYNE POTTER D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 7330 N 99TH AVE STE 200
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City | GLENDALE
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State | AZ
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Zip | 85307-3018
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Country | US
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Telephone | 602-406-3400
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Fax | 602-406-0270
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Provider Business Mailing Address
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Address Line | PO BOX 33269
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City | PHOENIX
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State | AZ
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Zip | 85067-3269
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 005313
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License Number State | AZ
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