Provider Demographics
NPI:1174637268
Name:POETTER & POETTER, P.A.
Entity Type:Organization
Organization Name:POETTER & POETTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIOLET
Authorized Official - Middle Name:D
Authorized Official - Last Name:POETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-351-5522
Mailing Address - Street 1:3002 SE 1ST AVE
Mailing Address - Street 2:#200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0477
Mailing Address - Country:US
Mailing Address - Phone:352-351-5522
Mailing Address - Fax:352-351-2950
Practice Address - Street 1:3002 SE 1ST AVE
Practice Address - Street 2:#200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0477
Practice Address - Country:US
Practice Address - Phone:352-351-5522
Practice Address - Fax:352-351-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3308103TC0700X
FLPY2970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174637268OtherNPI GROUP
FL21827OtherBCBS GROUP NUMBER
FLK0069Medicare ID - Type UnspecifiedMEDICARE GROUP #
FL21827OtherBCBS GROUP NUMBER