Basic Information
| Provider Information | |||||||||
| NPI: | 1619358603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRES POTTER | ||||||||
| FirstName: | LOSTY | ||||||||
| MiddleName: | TATIANA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 N WELCH AVE | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512450528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7129572310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 240 N RERICK AVE | ||||||||
| Address2: | |||||||||
| City: | PRIMGHAR | ||||||||
| State: | IA | ||||||||
| PostalCode: | 512457786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7129572310 | ||||||||
| FaxNumber: | 7129572300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD-47081 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.