Provider Demographics
NPI:1164679429
Name:POTTER, BRITTANY ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:ROCHELLE
Last Name:POTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 222093
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-2093
Mailing Address - Country:US
Mailing Address - Phone:972-291-9165
Mailing Address - Fax:469-575-9975
Practice Address - Street 1:716 N HIGHWAY 67 STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2117
Practice Address - Country:US
Practice Address - Phone:972-291-9165
Practice Address - Fax:469-575-9975
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN4677207Q00000X, 207QS0010X
TXBP10028876390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program