Charles R. Potter, M.d., L.l.c.

NPI #1538254727 in Decatur, Illinois

Provider Information

NPI Number: 1538254727
Entity Type: Organization
Organization Name: Charles R. Potter, M.d., L.l.c.
Primary Specialty: Otolaryngology
Enumeration Date: Oct 4, 2006
Last Updated: Jun 19, 2008

Practice Location

Address: 1770 E LAKE SHORE DR
Address 2: SUITE 306
City: Decatur
State: Illinois
ZIP Code: 62521-3832
Phone: (217) 422-1199

Authorized Official

Name: DR. CHARLES R POTTER, M.D.
Title: OWNER
Phone: (217) 422-1199

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Otolaryngology	207Y00000X	Primary

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