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General NPI Number Information
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NPI Number | 1902208440
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Entity Type | Individual
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Provider Name | ANISH GOVIND RADHAKRISHNAN POTTY M.D.,
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Gender | Male
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 7210 MCPHERSON RD STE 117
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City | LAREDO
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State | TX
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Zip | 78041-6505
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Country | US
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Telephone | 844-225-8463
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Fax | 956-242-0421
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Provider Business Mailing Address
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Address Line | 7210 MCPHERSON RD STE 117
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City | LAREDO
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State | TX
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Zip | 78041-6505
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Country | US
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Telephone | 844-225-8463
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Fax | 956-242-0421
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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 | ME121143
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | Q3076
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License Number State | TX
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