Powell, Gavin Ross

Powell, Gavin Ross is an sole proprietor health care provider with primary practice located at 318 2Nd St S , Nampa ID 83651-3765. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Powell, Gavin Ross can be contacted via phone (208) 467-3006.

Contact Information

Primary practice address
318 2Nd St S Nampa ID 83651-3765
Fax: (208) 467-1155
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X M7519 Idaho

Profile Details

NPI number 1215933940
LBN Legal business name Powell, Gavin Ross
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 27th, 2005
Last updated Oct 15th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215933940 NPPES
Idaho MEDICAID 805173400

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