Provider Demographics
NPI:1275846552
Name:POWERS, THOMAS SHELTON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SHELTON
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:412 OLIVE AVE # 489
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5142
Mailing Address - Country:US
Mailing Address - Phone:714-903-4570
Mailing Address - Fax:714-903-4571
Practice Address - Street 1:18821 DELAWARE ST
Practice Address - Street 2:#205
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1926
Practice Address - Country:US
Practice Address - Phone:714-903-4570
Practice Address - Fax:714-903-4571
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG15640208VP0000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services