Provider Demographics
NPI:1447363890
Name:URRUTIA-POTTER, IRMA E (MD)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:E
Last Name:URRUTIA-POTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:E
Other - Last Name:URRUTIA POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-616-6790
Mailing Address - Fax:520-616-1578
Practice Address - Street 1:1707 W SAINT MARYS RD STE 175
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2613
Practice Address - Country:US
Practice Address - Phone:520-616-6790
Practice Address - Fax:520-616-1578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59168207Q00000X, 207Q00000X
IL036112375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619414OtherBCBS GROUP
IL3633309286030501Medicaid
IL036112375Medicaid
ILK44858Medicare PIN
IL036112375Medicaid
K21852Medicare ID - Type Unspecified
IL3633309286030501Medicaid
I43779Medicare UPIN