Individual
TIMOTHY J POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD12182
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000188005
IND BLUE CROSS
OR
05
—
065847
—
OR
01
—
080120961
IND RAILROAD
OR
01
—
J406423
IND PACSOURCE
OR
Enumeration date
02/08/2006
Last updated
06/09/2020
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