MEDICARE: DR. KEVIN WAYNE 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	208600000X	Surgery Physician	005313	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z199540	OTHER	AZ	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1831355643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN WAYNE POTTER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	7330 N 99TH AVE STE 200A
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-3018
Country	:	US
Telephone Number	:	602-406-3400
Fax Number	:	602-406-0270

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

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	04/15/2026

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