Healthcare Provider Details

I. General information

NPI: 1760666879
Provider Name (Legal Business Name): DOUGLAS F POWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER- DEPT OF INTERNAL MEDICINE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER- DEPT OF INTERNAL MEDICINE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0208
  • Fax:
Mailing address:
  • Phone: 253-968-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number390200000X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: