Provider Demographics
NPI:1104117779
Name:POTOCKO, JOSHUA ROBEY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ROBEY
Last Name:POTOCKO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2807
Mailing Address - Country:US
Mailing Address - Phone:303-999-5763
Mailing Address - Fax:
Practice Address - Street 1:4437 CAMP ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2807
Practice Address - Country:US
Practice Address - Phone:303-999-5763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1461002083A0100X, 2083X0100X
LA345860261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health