Healthcare Provider Details

I. General information

NPI: 1043220643
Provider Name (Legal Business Name): WILLIAM R. POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E HOUSTON ST
TYLER TX
75702-8369
US

IV. Provider business mailing address

PO BOX 5500
TYLER TX
75712
US

V. Phone/Fax

Practice location:
  • Phone: 903-525-2992
  • Fax: 903-592-1934
Mailing address:
  • Phone: 903-324-6400
  • Fax: 903-326-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberE8826
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE8826
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: