Individual
JEFFREY C POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00040293
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31326021
—
NM
05
—
714635
—
AZ
05
—
83872540
—
CO
Enumeration date
12/07/2005
Last updated
01/04/2008
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