MEDICARE: MR. DAVID L POWELL MAT-CERT. SPECIALIST

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	174400000X	Specialist	A7-0359	CO

General Provider Information

NPI Number	:	1427207646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID L POWELL MAT-CERT. SPECIALIST

Provider Business Mailing Address
First Line	:	3914 GALILEO DR
Second Line	:	UNIT A
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3214
Country	:	US
Telephone Number	:	970-391-9259
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 DENROSE CT
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-8360
Country	:	US
Telephone Number	:	970-391-9259
Fax Number	:

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/11/2008

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