Individual
DR. DARRELL JACK POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5491 W ROSEBUD CT SE, #4, KENTWOOD, MI 49512-9464
(334) 322-3489
Mailing address
6214 SWEET CLOVER LN SE, CALEDONIA, MI 49316-8291
(334) 322-3489
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2006-01651
NC
207X00000X
Orthopaedic Surgery Physician
2016005465
MO
207X00000X
Orthopaedic Surgery Physician
Primary
4301030727
MI
207X00000X
Orthopaedic Surgery Physician
MD-42830
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41005
—
AL
01
—
51041005
BCBS
AL
Enumeration date
01/20/2006
Last updated
11/03/2019
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