Healthcare Provider Details

I. General information

NPI: 1740247899
Provider Name (Legal Business Name): ANTHONY MICHAEL POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CRANE STREET
MENLO PARK CA
94025-4429
US

IV. Provider business mailing address

1300 CRANE ST
MENLO PARK CA
94025-4260
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-6500
  • Fax:
Mailing address:
  • Phone: 888-924-1036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG80236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: