Healthcare Provider Details

I. General information

NPI: 1982109112
Provider Name (Legal Business Name): KARL JAMES EWERT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 KANELL BLVD
POPLAR BLUFF MO
63901-3001
US

IV. Provider business mailing address

2401 S 31ST ST # MS -A1202
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-785-4546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2021012663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: