Individual
JASON J. POTOCKI
Active
Individual
JASON J. POTOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
064444
GA
207X00000X
Orthopaedic Surgery Physician
60046
WI
207XS0117X
Orthopaedic Surgery of the Spine Physician
064444
GA
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
60046
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000485767
ANTHEM
KY
01
—
01062299A
PHYSICIAN LICENSE
IN
01
—
01062299B
CSR
IN
01
—
064444
LICENSE
GA
01
—
200700867
LICENSE
NC
01
—
200828920
IHCP
IN
01
—
40457
PHYSICIAN LICENSE
KY
01
—
60046-20
LICENSE
WI
Enumeration date
07/21/2006
Last updated
05/24/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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