Individual
DR. KEVIN WAYNE POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7330 N 99TH AVE STE 200A, GLENDALE, AZ 85307-3018
(602) 406-3400
(602) 406-0270
Mailing address
PO BOX 33269, PHOENIX, AZ 85067-3269
(602) 406-4786
(916) 636-4358
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
005313
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
445137
—
AZ
01
—
Z199540
MEDICARE
AZ
Enumeration date
07/31/2008
Last updated
04/15/2026
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