Provider Demographics
NPI:1942314547
Name:POTTER, STERLING GLADE (MD)
Entity Type:Individual
Prefix:DR
First Name:STERLING
Middle Name:GLADE
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 1:945 W HOSPITAL DR
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4214
Mailing Address - Country:US
Mailing Address - Phone:435-637-6190
Mailing Address - Fax:435-637-6317
Practice Address - Street 1:945 W HOSPITAL DR
Practice Address - Street 2:SUITE # 2
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4214
Practice Address - Country:US
Practice Address - Phone:435-637-6190
Practice Address - Fax:435-637-6317
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT165839-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63451Medicare UPIN