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Organization
IRA B POTTER PSC
Active
Organization
IRA B POTTER PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA BLAINE POTTER MD (PRESIDENT)
(606) 358-2381
Entity
Organization
Contact information
Practice address
77 MILLARD ALLEN DR., LACKEY, KY 41643-0190
(606) 358-2381
(606) 358-2404
Mailing address
PO BOX 190, 77 MILLARD ALLEN DRIVE, LACKEY, KY 41643-0190
(606) 358-2381
(606) 358-2404
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NULL
363A00000X
Physician Assistant
PA1587
KY
Other
Enumeration date
07/18/2005
Last updated
03/21/2016
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