MEDICARE: DR. GARREN MATTHEW POWELL MD

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	207N00000X	Dermatology Physician	2026022676	MO

General Provider Information

NPI Number	:	1598424749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARREN MATTHEW POWELL MD

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD STE 3019B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8267
Country	:	US
Telephone Number	:	314-509-5305
Fax Number	:	314-251-4454

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD STE 3019B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8267
Country	:	US
Telephone Number	:	314-509-5305
Fax Number	:	314-251-4454

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

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	06/01/2026

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