Provider Demographics
NPI:1700988656
Name:POWEL, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:POWEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9350 S 150 E STE 150
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2703
Mailing Address - Country:US
Mailing Address - Phone:801-903-5666
Mailing Address - Fax:801-984-8281
Practice Address - Street 1:9350 S 150 E STE 150
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2703
Practice Address - Country:US
Practice Address - Phone:801-903-5666
Practice Address - Fax:801-984-8281
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT183283-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTDA9470Medicare UPIN