MEDICARE: EMILY M 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	310263	LA
2	207ND0101X	MOHS-Micrographic Surgery Physician	310263	LA
3	390200000X	Student in an Organized Health Care Education/Training Program		LA
4	207ND0101X	MOHS-Micrographic Surgery Physician	12701270-1205	UT

General Provider Information

NPI Number	:	1861846149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY M POWELL MD

Provider Business Mailing Address
First Line	:	5734 S 1475 E STE 300
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4698
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

Provider Business Practice Location Address
First Line	:	5734 S 1475 E STE 300
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4698
Country	:	US
Telephone Number	:	801-475-5210
Fax Number	:	801-475-5209

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

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	01/10/2025

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