Provider Demographics
NPI:1629062237
Name:POTYKA, JAMES SMULLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SMULLIN
Last Name:POTYKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16414 SAN PEDRO AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2277
Mailing Address - Country:US
Mailing Address - Phone:210-495-9860
Mailing Address - Fax:210-495-9205
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-495-9860
Practice Address - Fax:210-495-9205
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0585146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00AP32Medicare ID - Type Unspecified
TXC20639Medicare UPIN