Provider Demographics
NPI:1053774455
Name:POWERS, BETHANY R (MD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:R
Last Name:POWERS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6322 S 3000 E STE 170
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7290
Mailing Address - Country:US
Mailing Address - Phone:801-513-3223
Mailing Address - Fax:
Practice Address - Street 1:6322 S 3000 E STE 170
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7290
Practice Address - Country:US
Practice Address - Phone:801-513-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI68626207Y00000X
UT12882240-8905207YX0905X
UT12882240-1205207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery