Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | E-0131 | AR |
N | 2080A0000X | Adolescent Medicine | ME0014112 | FL |
NPI | 1053339069 |
---|---|
Provider Name | David W Powers |
First Address | Inverness, FL 34451-2044 |
Second Address | Inverness, FL 34452-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11053 | BCBS (01) | FL |
592138484 | TAX ID (01) | FL |