Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | G22262 | CA |
NPI | 1154326601 |
---|---|
Provider Name | Richard E Powers |
First Address | Sebastopol, CA 95472-4226 |
Second Address | Sebastopol, CA 95472-4226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A41526 | (02) | CA |