Individual
DR. JERRY R POWELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E 9TH ST, ROCHESTER, IN 46975
(574) 224-1048
(574) 224-1103
Mailing address
1400 E 9TH ST, ROCHESTER, IN 46975-8937
(574) 224-1048
(574) 224-1103
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01053633A
IN
207Q00000X
Family Medicine Physician
Primary
01053633
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200001940A
—
IN
05
—
200231510
—
IN
Enumeration date
11/09/2005
Last updated
11/12/2019
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