MEDICARE: GREGORY D POWELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	J3877	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780677815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY D POWELL M.D.

Provider Business Mailing Address
First Line	:	5701 MAPLE AVE STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-6596
Country	:	US
Telephone Number	:	214-351-6600
Fax Number	:	214-351-6453

Provider Business Practice Location Address
First Line	:	4461 COIT RD STE 411
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-0526
Country	:	US
Telephone Number	:	972-244-3490
Fax Number	:	972-244-3490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	11/02/2021

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