Provider Demographics
NPI:1962485276
Name:POWERS, DAVID JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JEFFREY
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:1050 CRANBERRY RD
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576-0324
Mailing Address - Country:US
Mailing Address - Phone:907-842-1028
Mailing Address - Fax:907-842-9250
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:MEDICAL STAFF DEPARTMENT
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-9218
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2910Medicaid
8EZ701Medicare ID - Type Unspecified
8EZ502Medicare ID - Type Unspecified
8EZ631Medicare ID - Type Unspecified
8EZ641Medicare ID - Type Unspecified
AKMD2910Medicaid
8EZ521Medicare ID - Type Unspecified
8EZ651Medicare ID - Type Unspecified
8EZ671Medicare ID - Type Unspecified
8EZ681Medicare ID - Type Unspecified
8EZ531Medicare ID - Type Unspecified
8EZ551Medicare ID - Type Unspecified
8EZ611Medicare ID - Type Unspecified
C47916Medicare UPIN
8EZ601Medicare ID - Type Unspecified
8EZ621Medicare ID - Type Unspecified
8EZ661Medicare ID - Type Unspecified
8EZ691Medicare ID - Type Unspecified
8EZ711Medicare ID - Type Unspecified
8EZ512Medicare ID - Type Unspecified