MEDICARE: DR. DOREATHA JEAN POWELL D.O.

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	207Q00000X	Family Medicine Physician	M5447	TX
2	207Q00000X	Family Medicine Physician	4432	OK

General Provider Information

NPI Number	:	1417046418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOREATHA JEAN POWELL D.O.

Provider Business Mailing Address
First Line	:	9300 COIT RD
Second Line	:	#228
City	:	PLANO
State	:	TX
Zip	:	75025-4481
Country	:	US
Telephone Number	:	214-387-7899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 NORTH STEMMONS
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247
Country	:	US
Telephone Number	:	214-630-2331
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/02/2016

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Directions to “ DR. DOREATHA JEAN POWELL D.O.” Practice Location

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