Provider Demographics
NPI:1285779439
Name:POWELL, WILLIAM P (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 N MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1821
Mailing Address - Country:US
Mailing Address - Phone:541-488-1116
Mailing Address - Fax:541-488-6409
Practice Address - Street 1:595 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1821
Practice Address - Country:US
Practice Address - Phone:541-488-1116
Practice Address - Fax:541-488-6409
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO180017204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500717449Medicaid
OR500717449Medicaid
WAGAB38059Medicare Oscar/Certification
WAP00858055OtherRAILROAD MEDICARE
WAG8884101Medicare PIN