MEDICARE: DARYL K. POTTER D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	000271	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1054674	OTHER	KY	PASSPORT - GROUP
2	27-00311	OTHER	KY	UHC
3	P00112387	OTHER	KY	UHC RAILROAD
4	0620460004	OTHER	KY	PALMETTO - JEFFERSON CO
5	1157245	OTHER	KY	PASSPORT DME
6	000000332487	OTHER	KY	ANTHEM
7	2026979	OTHER	KY	CIGNA
8	5000492	OTHER	KY	PASSPORT - INDIVIDUAL
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0620460003	OTHER	KY	PALMETTO - HARDIN CO
11	7969602	OTHER	KY	AETNA
12	1214621	OTHER	KY	CHA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295739050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL K. POTTER D.P.M.

Provider Business Mailing Address
First Line	:	619 ASHBOURNE DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-7393
Country	:	US
Telephone Number	:	502-633-7649
Fax Number	:

Provider Business Practice Location Address
First Line	:	4612 OUTER LOOP
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-3971
Country	:	US
Telephone Number	:	502-968-2233
Fax Number	:	502-968-2283

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/09/2007

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