MEDICARE: MR. BLAKE REESE POTTER

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	247200000X	Other Technician		FL

General Provider Information

NPI Number	:	1588515993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAKE REESE POTTER

Provider Business Mailing Address
First Line	:	13609 RESTER RD
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-9391
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13609 RESTER RD
Second Line	:
City	:	GROVELAND
State	:	FL
Zip	:	34736-9391
Country	:	US
Telephone Number	:	352-227-0039
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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Directions to “ MR. BLAKE REESE POTTER ” Practice Location

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