Provider Demographics
NPI:1902850290
Name:POTTER, JAMES PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:POTTER
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 1:12497 BARONY DR
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-9619
Mailing Address - Country:US
Mailing Address - Phone:563-584-9172
Mailing Address - Fax:
Practice Address - Street 1:12497 BARONY DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-9619
Practice Address - Country:US
Practice Address - Phone:563-584-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27263207V00000X
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0239517Medicaid
IA0239517Medicaid
IAI17199Medicare ID - Type Unspecified