1962485276 NPI number — DAVID JEFFREY POWERS MD

Table of content: DAVID JEFFREY POWERS MD (NPI 1962485276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962485276 NPI number — DAVID JEFFREY POWERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWERS
Provider First Name:
DAVID
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962485276
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 324
Provider Second Line Business Mailing Address:
1050 CRANBERRY RD
Provider Business Mailing Address City Name:
DILLINGHAM
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99576-0324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-842-1028
Provider Business Mailing Address Fax Number:
907-842-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 KANAKANAK RD
Provider Second Line Business Practice Location Address:
MEDICAL STAFF DEPARTMENT
Provider Business Practice Location Address City Name:
DILLINGHAM
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-842-9218
Provider Business Practice Location Address Fax Number:
907-842-9250
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2190 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD2910 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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