Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 19656 | OH |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 19656 | OH |
NPI | 1013976695 |
---|---|
Provider Name | Dr. Richard L. Powell |
First Address | New Philadelphia, OH 44663-1243 |
Second Address | New Philadelphia, OH 44663-1243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0882077 | (05) | OH |
43-00090 | UNITED HEALTH CARE (01) | OH |
68035 | UNITED CONCORDIA (01) | OH |
U 32510 | (02) | OH |