Individual
JOHN L POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2570 NW EDENBOWER BLVD, SUITE 100, ROSEBURG, OR 97470-6220
(541) 677-7200
(541) 229-3364
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3364
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD19972
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000188013
IND BLUE CROSS
OR
01
—
080120962
IND RAILROAD
OR
05
—
150778
—
OR
01
—
J406411
IND PACSOURCE
OR
Enumeration date
02/09/2006
Last updated
12/11/2009
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