Provider Demographics
NPI:1902208440
Name:POTTY, ANISH GOVIND RADHAKRISHNAN (MD,)
Entity type:Individual
Prefix:
First Name:ANISH
Middle Name:GOVIND RADHAKRISHNAN
Last Name:POTTY
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7210 MCPHERSON RD STE 117
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6505
Mailing Address - Country:US
Mailing Address - Phone:844-225-8463
Mailing Address - Fax:956-242-0421
Practice Address - Street 1:7210 MCPHERSON RD STE 117
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6505
Practice Address - Country:US
Practice Address - Phone:844-225-8463
Practice Address - Fax:956-242-0421
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME121143207X00000X
TXQ3076207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347261501Medicaid
407935YTEOMedicare PIN