Healthcare Provider Details

I. General information

NPI: 1861846149
Provider Name (Legal Business Name): EMILY M POWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 S 1475 E STE 300
OGDEN UT
84403-4698
US

IV. Provider business mailing address

5734 S 1475 E STE 300
OGDEN UT
84403-4698
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-5210
  • Fax: 801-475-5209
Mailing address:
  • Phone: 801-475-5210
  • Fax: 801-475-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number310263
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number310263
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number12701270-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: