Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 036082587 | IL |
Y | 208600000X | Surgeon | 036082587 | IL |
NPI | 1003804006 |
---|---|
Provider Name | David Joseph Powers |
First Address | Dixon, IL 61021-0000 |
Second Address | Dixon, IL 61021-3190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 23/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036082587 | (05) | IL |
381220029 | MEDICARE (01) | IL |
Y11615 | (02) | IL |