Provider Demographics
NPI:1073808101
Name:POTENTA, SCOTT EDWARD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:POTENTA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-7101
Mailing Address - Country:US
Mailing Address - Phone:541-205-3974
Mailing Address - Fax:
Practice Address - Street 1:2900 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7101
Practice Address - Country:US
Practice Address - Phone:541-884-1317
Practice Address - Fax:541-274-4395
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1905542085R0202X
NC2018-000432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology