Individual
MR. ORIE R POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC MPAS
Contact information
Practice address
1400 E CARROLL, MACOMB, IL 61455
(309) 833-2500
(309) 833-1760
Mailing address
PO BOX 198, OQUAWKA, IL 61469-0198
(309) 867-2202
(309) 867-3205
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001876
IA
363A00000X
Physician Assistant
Primary
085000614
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371352599001
—
IL
Enumeration date
04/01/2006
Last updated
02/13/2024
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