Provider Demographics
| NPI: | 1962485276 |
|---|---|
| Name: | POWERS, DAVID JEFFREY (MD) |
| Entity Type: | Individual |
| Prefix: | |
| First Name: | DAVID |
| Middle Name: | JEFFREY |
| Last Name: | POWERS |
| Suffix: | |
| Gender: | M |
| Credentials: | MD |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | PO BOX 324 |
| Mailing Address - Street 2: | 1050 CRANBERRY RD |
| Mailing Address - City: | DILLINGHAM |
| Mailing Address - State: | AK |
| Mailing Address - Zip Code: | 99576-0324 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 907-842-1028 |
| Mailing Address - Fax: | 907-842-9250 |
| Practice Address - Street 1: | 6000 KANAKANAK RD |
| Practice Address - Street 2: | MEDICAL STAFF DEPARTMENT |
| Practice Address - City: | DILLINGHAM |
| Practice Address - State: | AK |
| Practice Address - Zip Code: | 99576 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 907-842-9218 |
| Practice Address - Fax: | 907-842-9250 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-11-22 |
| Last Update Date: | 2021-04-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| AK | 2190 | 207Q00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| AK | MD2910 | Medicaid | |
| 8EZ701 | Medicare ID - Type Unspecified | ||
| 8EZ502 | Medicare ID - Type Unspecified | ||
| 8EZ631 | Medicare ID - Type Unspecified | ||
| 8EZ641 | Medicare ID - Type Unspecified | ||
| AK | MD2910 | Medicaid | |
| 8EZ521 | Medicare ID - Type Unspecified | ||
| 8EZ651 | Medicare ID - Type Unspecified | ||
| 8EZ671 | Medicare ID - Type Unspecified | ||
| 8EZ681 | Medicare ID - Type Unspecified | ||
| 8EZ531 | Medicare ID - Type Unspecified | ||
| 8EZ551 | Medicare ID - Type Unspecified | ||
| 8EZ611 | Medicare ID - Type Unspecified | ||
| C47916 | Medicare UPIN | ||
| 8EZ601 | Medicare ID - Type Unspecified | ||
| 8EZ621 | Medicare ID - Type Unspecified | ||
| 8EZ661 | Medicare ID - Type Unspecified | ||
| 8EZ691 | Medicare ID - Type Unspecified | ||
| 8EZ711 | Medicare ID - Type Unspecified | ||
| 8EZ512 | Medicare ID - Type Unspecified |
