DR. JACK POTTS X (NPI# 1245348812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245348812 |
| Entity Type | Individual |
| Full Name | DR. JACK POTTS X |
| Credential | M.D. |
| Practice Address |
221 E Indianola Ave Phoenix AZ 85012-2002 |
| Practice Telephone | 6022745494 |
| Practice Fax Number | 6022645566 |
| Mailing Telephone | 6022745494 |
| Mailing Fax Number | 6022645566 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
AZ12185 | AZ | Allopathic & Osteopathic Physicians |
| X | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
12185 | AZ | Allopathic & Osteopathic Physicians |
| Street Address |
221 E INDIANOLA AVE |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85012-2002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720600042 | Lumana Ltd. Co | Local Education Agency (LEA) | 221 E Indianola Ave, Phoenix, AZ 85012-2002 | 2020-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881205417 | Diligence Physical Therapy and Wellness, Pllc | Physical Therapist | 3101 N. Central Avenue, Suite 183 # 518, Phoenix, AZ 85012 | 2020-08-17 |
| 1962023135 | Kelee Jade Forst | Student in an Organized Health Care Education/Training Program | 4001 N Third Street, Suite 290, Phoenix, AZ 85012 | 2020-04-29 |
| 1659911428 | Thomas James Blake | Social Worker | Phoenix Va Health Care System, 650 E Indian School Road, Phoenix, AZ 85012 | 2020-01-09 |
| 1598259467 | Luis F Fong | Registered Nurse | 3620 N. 3rd Street, Phoenix, AZ 85012 | 2018-06-14 |
| 1881196335 | Phoenix Surgical Solutions Pllc | Surgery | 6120 W Bell Rd Suite 130, Glendale, AZ 85012 | 2018-03-01 |
| 1679082523 | Christopher Ferguson | Physician Assistant | 1313 E. Osborn Rd., Ste 150, Phoenix, AZ 85012 | 2017-09-22 |
| 1861911323 | Viet Quoc Truong | Physician Assistant | 650 E Indian School Rd # 1, Phoenix, AZ 85012 | 2017-09-15 |
| 1720506389 | Erin Lynne Cody | Nurse Practitioner | 3003 N. 3rd St, Phoenix, AZ 85012 | 2017-09-05 |
| 1346694627 | Sharareh Najafi | Psychologist | 3450 N. 3rd Street, Phoenix, AZ 85012 | 2016-04-22 |
| 1548635824 | Rebekah June Daroff | Specialist/Technologist | 352 N Camelback Rd, Phoenix, AZ 85012 | 2015-12-11 |
| Find all providers in zip 85012 | ||||
| Taxonomy Code | 2084F0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Forensic Psychiatry |
| Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598937757 | Robert Lee Brewer | Psychiatry & Neurology | 2726 W Via Aquila, Phoenix, AZ 85086-6657 | 2008-03-27 |
| 1750422945 | Tariq Ghafoor | Psychiatry & Neurology | Arizona State Hospital, 2500 East Van Buren, Phoenix, AZ 85008 | 2007-02-09 |
| 1295794253 | John Gerard Garofalo | Psychiatry & Neurology | 5501 N 19th Ave, Suite 202, Phoenix, AZ 85015-2450 | 2006-03-20 |
| 1073696563 | Romeo Molo Abejuro Sr. | Psychiatry & Neurology | 650 E Indian School Rd, Phoenix, AS 85012-1839 | 2006-10-20 |
| 1659472785 | Marion Eleanor Sherman | Psychiatry & Neurology | 4212 N 16th St, Phoenix, AZ 85016 | 2006-09-25 |
| 1558339168 | Frantz Muse | Psychiatry & Neurology | 1209 S 1st Ave, Phoenix, AZ 85003-2605 | 2006-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124322151 | Bennett Blum | Psychiatry & Neurology | 5425 E Broadway Blvd, Pmb #358, Tucson, AZ 85711-3704 | 2011-01-05 |
| 1295700953 | Steven Herron | Psychiatry & Neurology | 5240 E Knight Dr Ste 100, Tucson, AZ 85712-2122 | 2006-02-17 |
| 1801398524 | Arizona Psychiatry, Pllc | Psychiatry & Neurology | 258 E River Rd Ste 110, Tucson, AZ 85704 | 2018-03-08 |
| 1104231851 | Tyler Dowling | Psychiatry & Neurology | 258 E River Rd Ste 110, Tucson, AZ 85704-5815 | 2014-06-20 |
| 1235557455 | Jessica A Harrison | Psychiatry & Neurology | 10000 S Wilmot Rd, Tucson, AZ 85756-8699 | 2014-04-03 |
| 1588000236 | Ian Christopher Lamoureux | Psychiatry & Neurology | 570 W Brown Rd, Mesa, AZ 85201 | 2013-05-21 |
| 1184711608 | Bernard M Morenz | Psychiatry & Neurology | 1501 N Campbell Ave, Tucson, AZ 85724-0001 | 2006-10-06 |
| 1821101817 | Anna S Scherzer | Psychiatry & Neurology | 10900 N Scottsdale Rd, Suite 502, Scottsdale, AZ 85254-5216 | 2006-08-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.