Individual
DR. JEFFREY DAVID POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
200 RICHMOND AVE E STE 1, MATTOON, IL 61938-4652
(217) 234-7000
(217) 234-7011
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.170637
IL
207R00000X
Internal Medicine Physician
DO-04963
IA
207R00000X
Internal Medicine Physician
OS019722
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/16/2013
Last updated
06/24/2024
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