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
Phone: (208) 467-3006
Fax: (208) 467-1155
Website:
Health care specialties
| Specialty | Code | License # | 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 19 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 | 1215933940 | NPPES |
| Idaho | MEDICAID | 805173400 |
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