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NPI Code Detail

MEDICARE: ROSE POTHEN M.D.

MEDICARE: ROSE POTHEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME68293FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154323178
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSE POTHEN M.D.
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-424-1400
Fax Number : 239-424-1421
Provider Business Practice Location Address
First Line : 16271 BASS RD
Second Line :
City : FT MYERS
State : FL
Zip : 33908-3616
Country : US
Telephone Number : 239-432-4235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/07/2008

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