Individual
BENJAMIN POTTEBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1378 NW 124TH ST STE 200, CLIVE, IA 50325-8151
(515) 288-6097
Mailing address
1378 NW 124TH ST STE 200, CLIVE, IA 50325-8151
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TL.0006064
CO
207RG0100X
Gastroenterology Physician
Primary
DO-06040
IA
207RG0100X
Gastroenterology Physician
DR.0059275
CO
Other
Enumeration date
06/27/2016
Last updated
07/13/2022
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