Individual
DAVID K POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 471-9466
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 471-9466
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
02037906
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092607
ANTHEM
IN
05
—
100323460
—
IN
01
—
1712
PHP
IN
05
—
2100612
—
OH
05
—
4074942100
—
MI
Enumeration date
05/22/2006
Last updated
07/13/2018
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