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Individual
MR. SAMUEL ERNEST POTTS
Active
Individual
MR. SAMUEL ERNEST POTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016004684
IL
213E00000X
Podiatrist
Primary
766
SC
213ER0200X
Radiology Podiatrist
016004684
IL
213ES0131X
Foot Surgery Podiatrist
016004684
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
230121
HEALTHLINK
—
01
—
480014432
PALMETTA GBA-RR MEDICARE
—
01
—
5805819
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/09/2006
Last updated
05/06/2024
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