Provider Demographics
NPI:1942260864
Name:POTTS, RICHARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:POTTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:1314 EAST WALNUT ST
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501
Mailing Address - Country:US
Mailing Address - Phone:812-254-7310
Mailing Address - Fax:812-254-8602
Practice Address - Street 1:202 NORTH WEST ST
Practice Address - Street 2:
Practice Address - City:ODON
Practice Address - State:IN
Practice Address - Zip Code:47562
Practice Address - Country:US
Practice Address - Phone:812-636-7300
Practice Address - Fax:812-636-8204
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000896A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000316823OtherANTHEM
INCA5604OtherMEDICARE RAILROAD GROUP
INP00179048OtherMEDICARE RAILROAD
IN100158940Medicaid
IN100158940Medicaid
D69639Medicare UPIN