Provider Demographics
NPI:1235120429
Name:POWERS, JOHN P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:POWERS
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:647 N BROAD STREET EXT
Mailing Address - Street 2:STE 204
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4604
Mailing Address - Country:US
Mailing Address - Phone:724-458-6245
Mailing Address - Fax:
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:SUITE 251
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-322-8460
Practice Address - Fax:520-323-5742
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004527R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ573536Medicaid
U86638Medicare UPIN
AZ67075Medicare PIN