Provider Demographics
NPI:1699124578
Name:POTTER, ADAM (MD, PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0570
Mailing Address - Country:US
Mailing Address - Phone:409-772-1533
Mailing Address - Fax:409-772-4985
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0553
Practice Address - Country:US
Practice Address - Phone:409-772-1553
Practice Address - Fax:409-747-4982
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10056511207R00000X
TXBP20065475207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine