Individual
IRA BLAINE POTTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
77 MILLARD ALLEN DR, LACKEY, KY 41643-0190
(606) 358-2381
(606) 358-2404
Mailing address
PO BOX 190, LACKEY, KY 41643-0190
(606) 358-2381
(606) 358-2404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15918
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045528
BCBS
KY
01
—
2139
CHA
KY
05
—
64159189
—
KY
Enumeration date
07/08/2005
Last updated
12/09/2011
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