Provider Demographics
NPI:1255323051
Name:POWNELL, PATRICK H (MD PA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:H
Last Name:POWNELL
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 GREENVILLE AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5105
Mailing Address - Country:US
Mailing Address - Phone:214-368-3223
Mailing Address - Fax:214-368-3177
Practice Address - Street 1:7115 GREENVILLE AVE STE 220
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5105
Practice Address - Country:US
Practice Address - Phone:214-368-3223
Practice Address - Fax:214-368-3177
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036ACMedicare ID - Type Unspecified
TXD87472Medicare UPIN