Provider Demographics
NPI:1912261033
Name:POWELL, ROBERT ALAN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36065 SANTE FE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-0001
Mailing Address - Country:US
Mailing Address - Phone:254-285-5533
Mailing Address - Fax:
Practice Address - Street 1:WOMACK ARMY MEDICAL
Practice Address - Street 2:2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8007
Practice Address - Fax:910-907-8630
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine