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Individual

KENNETH R POWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5050 S ROCHELLE AVE, SPRINGFIELD, MO 65804-7811
(417) 887-6294
Mailing address
5050 S. ROCHELLE AVE, SPRINGFIELD, MO 65804

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R5G68
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
107083
BLUE CROSS/BLUE SHIELD
05
202366001
MO
Enumeration date
06/14/2006
Last updated
06/26/2017
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