Individual
DR. KENT H POTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2307 GORDON COOPER DR, SHAWNEE, OK 74801-9007
(405) 878-4693
(405) 878-4690
Mailing address
12905 DEERFIELD CT, OKLAHOMA CITY, OK 73142-5138
(405) 752-0957
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
8526
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060051779
RAILROAD MEDICARE
OK
05
—
100104450A
—
OK
Enumeration date
10/04/2005
Last updated
07/07/2008
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