MEDICARE: DR. JORDAN TYLER POWNER D.O.

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	06106	CT
2	207RP1001X	Pulmonary Disease Physician	63819	CT

General Provider Information

NPI Number	:	1306100128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN TYLER POWNER D.O.

Provider Business Mailing Address
First Line	:	85 SEYMOUR STREET
Second Line	:	SUITE 923
City	:	HARTFORD
State	:	CT
Zip	:	06106
Country	:	US
Telephone Number	:	860-524-4550
Fax Number	:	860-524-4565

Provider Business Practice Location Address
First Line	:	85 SEYMOUR ST STE 923
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-5529
Country	:	US
Telephone Number	:	860-547-1876
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	04/01/2021

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