Basic Information
| Provider Information | |||||||||
| NPI: | 1003134107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 ELM ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757463400 | ||||||||
| FaxNumber: | 7757463411 | ||||||||
| Practice Location | |||||||||
| Address1: | 343 ELM ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757463400 | ||||||||
| FaxNumber: | 7757463411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 08/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 16044 | NV | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | A114887 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.