Individual
JOHN JACOB POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47473981206
UT
Other
Enumeration date
09/07/2005
Last updated
12/19/2013
Update your record
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