Provider Demographics
NPI:1871601377
Name:POWERS, WILLIAM R (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:POWERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-0147
Mailing Address - Country:US
Mailing Address - Phone:304-763-0352
Mailing Address - Fax:304-763-3681
Practice Address - Street 1:316 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3650
Practice Address - Country:US
Practice Address - Phone:304-763-0352
Practice Address - Fax:304-763-3681
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1087207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0071213000Medicaid
WV0071213000Medicaid
WV0864181Medicare PIN