Provider Demographics
NPI:1861441925
Name:POWELL, WES J (MD)
Entity Type:Individual
Prefix:DR
First Name:WES
Middle Name:J
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 1:950 S ARROYO PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3932
Mailing Address - Country:US
Mailing Address - Phone:626-765-6944
Mailing Address - Fax:626-449-4607
Practice Address - Street 1:950 S ARROYO PKWY FL 3
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3932
Practice Address - Country:US
Practice Address - Phone:626-765-6944
Practice Address - Fax:626-449-4607
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46628208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19118Medicare ID - Type Unspecified
CAF21863Medicare UPIN