Provider Demographics
NPI:1588602908
Name:POTTS, GINA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:POTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:VIKTORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 FROSTWOOD DR
Mailing Address - Street 2:SUITE 1.100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-4523
Mailing Address - Fax:
Practice Address - Street 1:6750 N MACARTHUR BLVD
Practice Address - Street 2:BUILDING 2, SUITE 150
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2420
Practice Address - Country:US
Practice Address - Phone:972-373-0303
Practice Address - Fax:972-373-8074
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7226208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041915203Medicaid
TX041915204Medicaid
TXG91559Medicare UPIN
TX83252KMedicare ID - Type Unspecified