Provider Demographics
NPI:1407019383
Name:POETTER, CONNIE E (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:E
Last Name:POETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 MEDICAL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-6602
Mailing Address - Country:US
Mailing Address - Phone:813-780-2550
Mailing Address - Fax:813-780-3012
Practice Address - Street 1:6938 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6602
Practice Address - Country:US
Practice Address - Phone:813-780-2550
Practice Address - Fax:813-780-3012
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1052572084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry