Provider Demographics
NPI:1003881020
Name:POTOCSNAK, JAMES (PAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:POTOCSNAK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201
Mailing Address - Country:US
Mailing Address - Phone:425-259-5121
Mailing Address - Fax:425-252-1322
Practice Address - Street 1:2320 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:425-259-5121
Practice Address - Fax:425-252-1322
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001718363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R31782Medicare ID - Type Unspecified
WAA09232Medicare UPIN