Provider Demographics
NPI:1760619944
Name:DAVID W POWELL MD DERMATOLOGY PA
Entity Type:Organization
Organization Name:DAVID W POWELL MD DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-208-9344
Mailing Address - Street 1:1327 LAKE POINTE PKWY
Mailing Address - Street 2:SUITE 416
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4095
Mailing Address - Country:US
Mailing Address - Phone:281-494-0050
Mailing Address - Fax:281-494-0075
Practice Address - Street 1:1327 LAKE POINTE PKWY
Practice Address - Street 2:SUITE 416
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4095
Practice Address - Country:US
Practice Address - Phone:281-494-0050
Practice Address - Fax:281-494-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9788207N00000X
TXPA05189363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4682Medicare PIN