Provider Demographics
NPI:1740348747
Name:POTTER, RALPH DAVID (NMD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DAVID
Last Name:POTTER
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 E MORGAN TRL
Mailing Address - Street 2:SUITE #5A
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1232
Mailing Address - Country:US
Mailing Address - Phone:480-603-9273
Mailing Address - Fax:
Practice Address - Street 1:8040 E MORGAN TRL
Practice Address - Street 2:SUITE #5A
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-1232
Practice Address - Country:US
Practice Address - Phone:480-603-9273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-800175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath