Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A116516 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A116516 | CA |
NPI | 1174755789 |
---|---|
Provider Name | Thomas William Powers |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Elk Grove, CA 95757-6297 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 17/12/2021 |