Provider Demographics
NPI:1619358603
Name:TORRES POTTER, LOSTY TATIANA (MD)
Entity Type:Individual
Prefix:
First Name:LOSTY
Middle Name:TATIANA
Last Name:TORRES POTTER
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 1:255 N WELCH AVE
Mailing Address - Street 2:
Mailing Address - City:PRIMGHAR
Mailing Address - State:IA
Mailing Address - Zip Code:51245-0528
Mailing Address - Country:US
Mailing Address - Phone:712-957-2310
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST STE 5436
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2950
Practice Address - Fax:712-279-2520
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-47081207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism