Provider Demographics
NPI:1750302436
Name:POWELL, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MARKET ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1332
Mailing Address - Country:US
Mailing Address - Phone:502-587-8000
Mailing Address - Fax:502-583-8001
Practice Address - Street 1:100 W MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1332
Practice Address - Country:US
Practice Address - Phone:502-587-8000
Practice Address - Fax:502-583-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14501207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64145014Medicaid
KY00000052088OtherANTHEM
IN084750FMedicare ID - Type Unspecified
KY00000052088OtherANTHEM
KY64145014Medicaid