Provider Demographics
NPI:1689994303
Name:RICHARD DANIEL POTTS MD PLLC
Entity type:Organization
Organization Name:RICHARD DANIEL POTTS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-509-9994
Mailing Address - Street 1:125 OCEAN SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-5734
Mailing Address - Country:US
Mailing Address - Phone:386-506-9994
Mailing Address - Fax:
Practice Address - Street 1:26 N BEACH ST STE C
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5656
Practice Address - Country:US
Practice Address - Phone:386-506-9994
Practice Address - Fax:386-281-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH987ZMedicare PIN