Individual
EDWARD JAMES POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
171 W CENTRAL AVE, COOLIDGE, AZ 85228-4405
(520) 723-7726
(520) 723-4513
Mailing address
171 W CENTRAL AVE, COOLIDGE, AZ 85228-4405
(520) 723-7726
(520) 723-4513
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1252
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03D09444436
CLIA
AZ
05
—
740052
—
AZ
Enumeration date
11/08/2006
Last updated
03/07/2023
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