Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | P02943 | FL |
NPI | 1013966753 |
---|---|
Provider Name | Mr. Chris M Powell |
First Address | St Petersburg, FL 33710-8240 |
Second Address | St Petersburg, FL 33710-8240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
801705 | (05) | FL |
U86403 | (02) | FL |