Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 01060100A | IN |
Y | 208200000X | Surgeon | 01060100A | IN |
Y | 208600000X | Surgeon | 01060100A | IN |
NPI | 1407806029 |
---|---|
Provider Name | John Abram Powelson |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 28/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200506770A | (05) | IN |
F53371 | (02) | IN |