Provider Demographics
NPI:1417052283
Name:POTTER, THOMAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 KUKUI GROVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2006
Mailing Address - Country:US
Mailing Address - Phone:808-246-6904
Mailing Address - Fax:808-246-6081
Practice Address - Street 1:4366 KUKUI GROVE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2006
Practice Address - Country:US
Practice Address - Phone:808-246-6904
Practice Address - Fax:808-246-6081
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-9464207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology