Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2764261205 | UT |
N | 207NS0135X | Procedural Dermatology | 2764261205 | UT |
NPI | 1043316300 |
---|---|
Provider Name | Dr. Douglas L Powell |
First Address | Salt Lake City, UT 84110-3208 |
Second Address | Salt Lake City, UT 84132-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002082671 | (05) | NV |
806051301 | (05) | ID |
870468377001 | (05) | UT |
H10194 | (02) | UT |
MD120UT | (05) | AK |