Individual
JORDAN RICHARD POTHAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
730 W MARKET ST, LIMA, OH 45801-4602
(192) 273-3614
Mailing address
730 W MARKET ST, LIMA, OH 45801-4602
(192) 273-3614
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
50.006748RX
OH
363A00000X
Physician Assistant
Primary
50.006748RX
OH
Other
Enumeration date
08/27/2014
Last updated
08/20/2021
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