MEDICARE: DR. MICHAEL W POTTER 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
1	207T00000X	Neurological Surgery Physician	5552	SD
2	207T00000X	Neurological Surgery Physician	10071	ND
3	207T00000X	Neurological Surgery Physician	MD19851	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1245230143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL W POTTER M.D.

Provider Business Mailing Address
First Line	:	100 DEAN DR
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-9706
Country	:	US
Telephone Number	:	541-944-1490
Fax Number	:	541-664-8291

Provider Business Practice Location Address
First Line	:	100 DEAN DR
Second Line	:
City	:	CENTRAL POINT
State	:	OR
Zip	:	97502-9706
Country	:	US
Telephone Number	:	541-944-1490
Fax Number	:	541-664-8291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/23/2013

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