Individual
TED BLAKE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 HOSPITAL PARKWAY, BEDFORD, TX 76022-6913
(214) 638-2000
(214) 631-6724
Mailing address
1355 RIVER BEND DRIVE, DALLAS, TX 75247-4915
(214) 638-2000
(214) 631-6724
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
G8949
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102314501
—
TX
01
—
220017764
RAILROAD MEDICARE
TX
01
—
83P491
BCBS
TX
Enumeration date
08/03/2006
Last updated
10/01/2015
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