Provider Demographics
NPI:1427207646
Name:POWELL, DAVID L (MAT-CERT SPECIALIST)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:POWELL
Suffix:
Gender:M
Credentials:MAT-CERT SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 GALILEO DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3214
Mailing Address - Country:US
Mailing Address - Phone:970-391-9259
Mailing Address - Fax:
Practice Address - Street 1:4450 DENROSE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-8360
Practice Address - Country:US
Practice Address - Phone:970-391-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COA7-0359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist