Provider Demographics
NPI:1912921701
Name:POWELL, DAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:C
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:20821 US HWY 281 NORTH
Practice Address - Street 2:SUITE 122
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7595
Practice Address - Country:US
Practice Address - Phone:210-546-1600
Practice Address - Fax:210-546-1610
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84V313OtherBCBS
TXJ3370OtherWORKERS COMPENSATION
TXJ3370OtherUNICARE
TX121736100OtherSOUTHWEST LIFE & HEALTH
TX121736100OtherFIRST CARE
TX1186100001OtherDMERC
TX125572103Medicaid
TX80062108OtherRAILROAD MEDICARE
TXJ3370OtherUNICARE
TXF80882Medicare UPIN