Healthcare Provider Details

I. General information

NPI: 1235125295
Provider Name (Legal Business Name): JAMES EDSON POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N PRAIRIE ST
FLANDREAU SD
57028-1243
US

IV. Provider business mailing address

212 N PRAIRIE ST
FLANDREAU SD
57028-1243
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-2471
  • Fax: 605-997-2418
Mailing address:
  • Phone: 605-997-2471
  • Fax: 605-997-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2098
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: