Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01066313A | IN |
N | 208800000X | Urologist | 125044893 | IL |
N | 208800000X | Urologist | 37723 | IA |
NPI | 1013125871 |
---|---|
Provider Name | Dr. Charles Randall Powell JR. |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200950830 | (05) | IN |