Provider Demographics
NPI:1609057751
Name:POWELL, BETHANY ELISE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:ELISE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:777 S FRY RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2244
Mailing Address - Country:US
Mailing Address - Phone:281-647-9950
Mailing Address - Fax:281-647-9960
Practice Address - Street 1:777 S FRY RD
Practice Address - Street 2:STE. 105
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2244
Practice Address - Country:US
Practice Address - Phone:281-647-9950
Practice Address - Fax:281-647-9960
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2013-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL3073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH54507Medicare UPIN