Provider Demographics
NPI:1154005247
Name:POWELL, MARVIN II
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:POWELL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 BRIAR FOREST DR APT 3807
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1048
Mailing Address - Country:US
Mailing Address - Phone:346-317-1369
Mailing Address - Fax:
Practice Address - Street 1:9449 BRIAR FOREST DR APT 3807
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1048
Practice Address - Country:US
Practice Address - Phone:346-317-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor