MEDICARE: DR. BETHANY R POWERS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	68626	WI
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	12882240-8905	UT
3	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	12882240-1205	UT

General Provider Information

NPI Number	:	1053774455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETHANY R POWERS M.D.

Provider Business Mailing Address
First Line	:	6322 S 3000 E STE 170
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7290
Country	:	US
Telephone Number	:	801-513-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	6322 S 3000 E STE 170
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-7290
Country	:	US
Telephone Number	:	801-513-3223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2016
Last Update Date	:	12/10/2025

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