Individual
DR. GAVIN ROSS POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
318 2ND ST S, NAMPA, ID 83651-3765
(208) 467-3006
(208) 467-1155
Mailing address
318 2ND ST S, NAMPA, ID 83651-3765
(208) 467-3006
(208) 467-1155
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
M7519
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805173400
—
ID
Enumeration date
06/27/2005
Last updated
10/15/2007
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