Individual
JOHN ROGER POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 13TH ST, ASHLAND, KY 41101
(606) 329-0204
(606) 324-7770
Mailing address
700 13TH ST, ASHLAND, KY 41101
(606) 329-0204
(606) 324-7770
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17883
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062599
ANTHEM BC PROVIDER
KY
05
—
0110220000
—
WV
05
—
0406617
—
OH
01
—
12-029969
UNITED HEALTH CARE
KY
01
—
22000000063411
ANTHEM BC/BS
KY
01
—
336109752062212
BC SUPER BLUE PLUS
KY
01
—
610975206003
MT ST BC/BS
KY
01
—
6109752062212
BC PPO
KY
05
—
64178833
—
KY
05
—
65917544
—
KY
Enumeration date
10/02/2006
Last updated
07/09/2007
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