Provider Demographics
NPI:1609894187
Name:POWELL, MATTHEW A (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3181
Mailing Address - Fax:314-362-2893
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV OBGYN GYNECOLOGIC ONCOLOGY, STE 13C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3181
Practice Address - Fax:314-362-2893
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO118596207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205836307Medicaid
MO205836307Medicaid
MO081010217Medicaid
MO980000399Medicare PIN