Provider Demographics
NPI:1578779484
Name:POWELL, FRANK EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:EVANS
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1697 W ARTESIA BLVD # 205
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3219
Mailing Address - Country:US
Mailing Address - Phone:310-323-9707
Mailing Address - Fax:310-323-9707
Practice Address - Street 1:1697 W ARTESIA BLVD # 205
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3219
Practice Address - Country:US
Practice Address - Phone:310-323-9707
Practice Address - Fax:310-323-9707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC22871207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C228710Medicaid
CAC22871Medicare ID - Type UnspecifiedMEDICARE ID#
CA00C228710Medicaid