MEDICARE: ANDREW B POWELL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0010	NV
2	213ES0103X	Foot & Ankle Surgery Podiatrist	0010	NV
3	213E00000X	Podiatrist	373663-0501	UT
4	213ES0103X	Foot & Ankle Surgery Podiatrist	373663-0501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW B POWELL DPM

Provider Business Mailing Address
First Line	:	754 SOUTH MAIN
Second Line	:	SUITE 3
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-628-2671
Fax Number	:	435-634-1601

Provider Business Practice Location Address
First Line	:	754 SOUTH MAIN
Second Line	:	SUITE 3
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5504
Country	:	US
Telephone Number	:	435-628-2671
Fax Number	:	435-634-1601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/13/2014

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Directions to “ ANDREW B POWELL DPM” Practice Location

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