Provider Demographics
NPI:1497757587
Name:POTTENGER, ROY N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:N
Last Name:POTTENGER
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 1:6403 COYLE AVE
Mailing Address - Street 2:STE 170
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0363
Mailing Address - Country:US
Mailing Address - Phone:916-965-4000
Mailing Address - Fax:916-965-4813
Practice Address - Street 1:6403 COYLE AVE
Practice Address - Street 2:STE 170
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0363
Practice Address - Country:US
Practice Address - Phone:916-965-4000
Practice Address - Fax:916-965-4813
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC39298207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4292600001OtherDME SUPPLIER NUMBER
CAA37108Medicare UPIN
CA00C392980Medicare ID - Type Unspecified