Individual
STAN E POTOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3621 22ND ST, STE 300, LUBBOCK, TX 79410-1301
(806) 792-5331
(806) 792-9417
Mailing address
3621 22ND ST, STE 300, LUBBOCK, TX 79410-1301
(806) 792-5331
(806) 792-9417
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
J8719
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029832501
—
TX
01
—
040016967
RAILROAD MEDICARE
TX
01
—
88681X
BC/BS
TX
Enumeration date
06/05/2006
Last updated
06/23/2009
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