Powell, Jerry R

Powell, Jerry R is an individual health care provider with primary practice located at 1400 E 9Th St , Rochester IN 46975. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Powell, Jerry R can be contacted via phone (574) 224-1048.

Contact Information

Primary practice address
1400 E 9Th St Rochester IN 46975
Phone: (574) 224-1048
Fax: (574) 224-1103
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01053633A Indiana
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01053633 Indiana

Profile Details

NPI number 1619958378
LBN Legal business name Powell, Jerry R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2005
Last updated Nov 12th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619958378 NPPES
Indiana MEDICAID 200001940A
Indiana MEDICAID 200231510

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