Individual
JASON ALLEN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-6511
(336) 716-2255
Mailing address
MEDICAL CENTER BLVD, PROVIDER ENROLLMENT, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2014-01064
NC
2085R0203X
Therapeutic Radiology Physician
ME115630
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134312A
—
GA
05
—
008783400
—
FL
01
—
14Q2V
BLUE CROSS
FL
Enumeration date
06/23/2008
Last updated
12/03/2020
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