MEDICARE: DR. DAVID EDMUND POTTER D.O.

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	207Q00000X	Family Medicine Physician	G8347	TX
2	302R00000X	Health Maintenance Organization	G8347	TX

General Provider Information

NPI Number	:	1639472632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID EDMUND POTTER D.O.

Provider Business Mailing Address
First Line	:	4757 WILLOW BEND DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-1023
Country	:	US
Telephone Number	:	940-696-8139
Fax Number	:

Provider Business Practice Location Address
First Line	:	2101 FM 369 N
Second Line	:
City	:	IOWA PARK
State	:	TX
Zip	:	76367-6568
Country	:	US
Telephone Number	:	940-855-7477
Fax Number	:

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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