Organization
POWELL ORTHOPEDICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK W POWELL M.D. (OWNER)
(479) 582-4647
Entity
Organization
Contact information
Practice address
3714 N BUSINESS DR STE 101, FAYETTEVILLE, AR 72703-5289
(479) 582-4647
(479) 582-4660
Mailing address
PO BOX 9688, FAYETTEVILLE, AR 72703-0030
(479) 582-4647
(479) 582-4660
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
E1304
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136406002
—
AR
Enumeration date
05/03/2007
Last updated
01/11/2012
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