Healthcare Provider Details

I. General information

NPI: 1689985087
Provider Name (Legal Business Name): JAMES DAVID SILLS-POWELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CROSSWINDS DR
WENTZVILLE MO
63385-4832
US

IV. Provider business mailing address

1776 CROSSWINDS DR
WENTZVILLE MO
63385-4832
US

V. Phone/Fax

Practice location:
  • Phone: 314-735-5197
  • Fax: 314-338-3495
Mailing address:
  • Phone: 314-735-5197
  • Fax: 314-338-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2012040658
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2012040658
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: