Provider Demographics
NPI:1417046418
Name:POWELL, DOREATHA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DOREATHA
Middle Name:JEAN
Last Name:POWELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:J
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9300 COIT RD
Mailing Address - Street 2:#228
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4481
Mailing Address - Country:US
Mailing Address - Phone:214-387-7899
Mailing Address - Fax:
Practice Address - Street 1:2920 NORTH STEMMONS
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-630-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5447207Q00000X
OK4432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151686Medicare PIN