Provider Demographics
NPI:1235265802
Name:POWEL, TANYA K (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:K
Last Name:POWEL
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 1:9350 S 150 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2703
Mailing Address - Country:US
Mailing Address - Phone:180-190-3566
Mailing Address - Fax:180-198-4828
Practice Address - Street 1:9350 S 150 E STE 150
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2703
Practice Address - Country:US
Practice Address - Phone:180-190-3566
Practice Address - Fax:180-198-4828
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT 183278-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTB74524Medicare UPIN