Provider Demographics
NPI:1154326601
Name:POWERS, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PALM AVE
Mailing Address - Street 2:STE A
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4226
Mailing Address - Country:US
Mailing Address - Phone:707-823-5341
Mailing Address - Fax:707-823-8638
Practice Address - Street 1:6800 PALM AVE
Practice Address - Street 2:STE A
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4226
Practice Address - Country:US
Practice Address - Phone:707-823-5341
Practice Address - Fax:707-823-8638
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22262207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41526Medicare UPIN