Provider Demographics
NPI:1831142868
Name:POETTCKER, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:POETTCKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1604 HOSPITAL PARKWAY
Mailing Address - Street 2:#505
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-267-2678
Mailing Address - Fax:817-354-0854
Practice Address - Street 1:1604 HOSPITAL PARKWAY
Practice Address - Street 2:#505
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-267-2678
Practice Address - Fax:817-354-0854
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXCERT28481, LICE8821208600000X
TXE8821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120391101Medicaid
TNE8821OtherSTATE ID #
TNE8821OtherSTATE ID #
TXB25558Medicare UPIN