Provider Demographics
NPI:1871665943
Name:POWELL, BRUCE FREDERICK (MD, MA)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FREDERICK
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17770 SW NEUGEBAUER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9443
Mailing Address - Country:US
Mailing Address - Phone:503-628-9120
Mailing Address - Fax:
Practice Address - Street 1:17770 SW NEUGEBAUER RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-9443
Practice Address - Country:US
Practice Address - Phone:503-628-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR208652084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54357Medicare UPIN