Provider Demographics
NPI:1760458897
Name:POWELL, CHARLES LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LEE
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6161 N STATE HIGHWAY 161
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2220
Mailing Address - Country:US
Mailing Address - Phone:972-258-7499
Mailing Address - Fax:972-257-0897
Practice Address - Street 1:6161 N STATE HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-258-7499
Practice Address - Fax:972-257-0897
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM0870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM0870OtherLICENSE
TX8D4300OtherMEDICARE NUMBER
TX171755501Medicaid