Individual
BRIAN J POTTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3264 N NORTH HILLS BLVD, FAYETTEVILLE, AR 72703-4005
(479) 521-3300
(479) 521-4705
Mailing address
PO BOX 550, LOWELL, AR 72745-0550
(479) 463-7775
(479) 463-7187
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
DR.0053920
CO
208600000X
Surgery Physician
Primary
E-13809
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
53920
COLORADO MEDICAL BOARD
CO
Enumeration date
06/22/2009
Last updated
02/12/2021
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