Provider Demographics
NPI:1871799809
Name:POWELL, DYRON EVERETTE SR (PAC)
Entity type:Individual
Prefix:MR
First Name:DYRON
Middle Name:EVERETTE
Last Name:POWELL
Suffix:SR
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 NORTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339
Mailing Address - Country:US
Mailing Address - Phone:281-360-8501
Mailing Address - Fax:281-360-8617
Practice Address - Street 1:3036 NORTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-360-8501
Practice Address - Fax:281-360-8617
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant