Provider Demographics
NPI:1215940358
Name:POTTS, JASON ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ROBERT
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 PINE LAKE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-421-3240
Mailing Address - Fax:402-423-0739
Practice Address - Street 1:3901 PINE LAKE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5497
Practice Address - Country:US
Practice Address - Phone:402-421-3240
Practice Address - Fax:402-423-0739
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H59876Medicare UPIN
275510Medicare ID - Type Unspecified