Provider Demographics
NPI:1932154903
Name:POTTS, BRIAN CURTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CURTIS
Last Name:POTTS
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 1:4411 THE 25 WAY NE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5857
Mailing Address - Country:US
Mailing Address - Phone:505-332-6919
Mailing Address - Fax:505-332-6921
Practice Address - Street 1:4411 THE 25 WAY NE
Practice Address - Street 2:SUITE 150
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5857
Practice Address - Country:US
Practice Address - Phone:505-332-6919
Practice Address - Fax:505-332-6921
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA347852085R0202X
NM2003-06182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19370OtherBLUE CROSS BLUE SHIELD
IA2282988Medicaid
IA33508OtherBLUE CROSS BLUE SHIELD
NM63383560Medicaid
IA33509OtherBLUE CROSS BLUE SHIELD
IA0282988Medicaid
IA1282988Medicaid
IA36841OtherBLUE CROSS BLUE SHIELD
IA36841OtherBLUE CROSS BLUE SHIELD
IA1282988Medicaid