Healthcare Provider Details

I. General information

NPI: 1295701456
Provider Name (Legal Business Name): DAVID WILLIAM POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 RUE LOUIS XIV BLDG 5A
LAFAYETTE LA
70508-5787
US

IV. Provider business mailing address

121 RUE LOUIS XIV BLDG 5A
LAFAYETTE LA
70508-5787
US

V. Phone/Fax

Practice location:
  • Phone: 713-208-9344
  • Fax:
Mailing address:
  • Phone: 713-208-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberJ9788
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number021910
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: