Provider Demographics
NPI:1073510228
Name:POWELL, TAMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 NE LYNDA LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3599
Mailing Address - Country:US
Mailing Address - Phone:541-476-3000
Mailing Address - Fax:541-479-5101
Practice Address - Street 1:1690 NE LYNDA LN
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-3599
Practice Address - Country:US
Practice Address - Phone:541-476-3000
Practice Address - Fax:541-479-5101
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130020Medicaid
OR130020Medicaid
OR107212Medicare ID - Type Unspecified