Individual
MATTHEW D POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4023
Mailing address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4023
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0471
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71052
—
ND
Enumeration date
12/29/2011
Last updated
10/17/2012
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