Provider Demographics
NPI:1437152451
Name:POWELL, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2121
Mailing Address - Country:US
Mailing Address - Phone:217-540-2350
Mailing Address - Fax:217-347-2323
Practice Address - Street 1:900 W TEMPLE AVE STE 2500
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-540-2350
Practice Address - Fax:217-347-2323
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36509207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
43803OtherCMR
4441V6097OtherHEALTHCARE USA
9045OtherEXCLUSIVE CHOICE
MO23266OtherBLUE CROSS BLUE SHIELD
900096OtherUHC
SP11098OtherCIGNA
2819V3458OtherGHP/ADVANTRA
108839OtherHEALTHLINK
4061206OtherAETNA
9045OtherEXCLUSIVE CHOICE
MO201155070Medicare ID - Type UnspecifiedRAILROAD
43803OtherCMR
MO990000528Medicare ID - Type Unspecified