Provider Demographics
NPI:1962734053
Name:POWELL, DARRYL HOMER (POWELL DARRYL)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:HOMER
Last Name:POWELL
Suffix:
Gender:M
Credentials:POWELL DARRYL
Other - Prefix:DR
Other - First Name:DARRYL
Other - Middle Name:HOMER
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:POWELL DARRYL, MD
Mailing Address - Street 1:3100 MOUNTAIN SHADOW
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6646
Mailing Address - Country:US
Mailing Address - Phone:432-267-4902
Mailing Address - Fax:432-267-4902
Practice Address - Street 1:3100 MOUNTAIN SHADOW
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6646
Practice Address - Country:US
Practice Address - Phone:432-267-4902
Practice Address - Fax:432-267-4902
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8406208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery