Powell, Theo Herbert
Powell, Theo Herbert is an individual health care provider with primary practice located at 495 Sw Ramsey Ave , Grants Pass OR 97527. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Powell, Theo Herbert can be contacted via phone (541) 476-6644.Contact Information
Primary practice address
495 Sw Ramsey Ave
Grants Pass OR 97527
Phone: (541) 476-6644
Fax: (541) 472-5673
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD11637 | Oregon |
Profile Details
| NPI number | 1164427951 |
|---|---|
| LBN Legal business name | Powell, Theo Herbert |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 17th, 2005 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164427951 | NPPES |
| Oregon | MEDICAID | 074527 |
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