Individual
JERRY LYNN POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1408 W 43RD AVE, PINE BLUFF, AR 71603-7010
(870) 535-5719
(870) 536-1963
Mailing address
1408 W 43RD AVE, PINE BLUFF, AR 71603-7010
(870) 535-5719
(870) 536-1963
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
C4520
AR
207KA0200X
Allergy Physician
C4520
AR
207Y00000X
Otolaryngology Physician
Primary
C4520
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104787001
—
AR
01
—
54134
ARKANSAS BLUE CROSS BLUE SHIELD
AR
Enumeration date
02/28/2006
Last updated
08/21/2008
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