Provider Demographics
NPI:1689868622
Name:POTTS, CHARLES EUGENE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EUGENE
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 W EAU GALLIE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7215
Mailing Address - Country:US
Mailing Address - Phone:866-846-4827
Mailing Address - Fax:321-751-6998
Practice Address - Street 1:8000 RON BEATTY BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:BAREFOOT BAY
Practice Address - State:FL
Practice Address - Zip Code:32976-7474
Practice Address - Country:US
Practice Address - Phone:321-751-6671
Practice Address - Fax:772-664-1561
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128442207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024494300Medicaid
DC4419270Medicaid
H27078Medicare UPIN