Individual
DR. JONATHAN LARMOUR POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
HIGHWAY 191, CHINLE HOSPITAL, CHINLE, AZ 86503-1921
(917) 504-6337
Mailing address
PO BOX 1921, CHINLE, AZ 86503-1921
(917) 504-6337
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A132545
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170247
—
AZ
Enumeration date
11/03/2013
Last updated
01/04/2017
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