Provider Demographics
NPI:1538162177
Name:POWELL, JOSHUA TRENT (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TRENT
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 24TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6314
Mailing Address - Country:US
Mailing Address - Phone:405-701-8408
Mailing Address - Fax:405-701-8407
Practice Address - Street 1:816 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6314
Practice Address - Country:US
Practice Address - Phone:405-286-3937
Practice Address - Fax:405-701-8407
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22418207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200061720AMedicaid
OK2532367OtherUNITED HEALTHCARE
OK7429688OtherAETNA
OKP00252421Medicare PIN
OK200061720AMedicaid
OKI34468Medicare UPIN