MEDICARE: JAMES G POTTER PA-C

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	363A00000X	Physician Assistant	3621-23	WI

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	1018475	OTHER		PREFERREDONE

General Provider Information

NPI Number	:	1669470845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES G POTTER PA-C

Provider Business Mailing Address
First Line	:	ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
Second Line	:	400 EAST THIRD STREET
City	:	DULUTH
State	:	MN
Zip	:	55805-1951
Country	:	US
Telephone Number	:	218-786-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 TOWER AVENUE
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-5335
Country	:	US
Telephone Number	:	715-817-7100
Fax Number	:

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/09/2016

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