Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | K7488 | TX |
Y | 207QA0401X | Family Doctor - Addiction Medicine | K7488 | TX |
NPI | 1891714929 |
---|---|
Provider Name | Jason Z.w. Powers |
First Address | Houston, TX 77074-1802 |
Second Address | Houston, TX 77006-4604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34450 | (02) | TX |