MEDICARE: KELLY POWERS ROVEDA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0006X	Clinical Pathology Physician	16954	AL
2	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	16954	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235110883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY POWERS ROVEDA MD

Provider Business Mailing Address
First Line	:	PO BOX 40480
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36640-0480
Country	:	US
Telephone Number	:	251-471-7790
Fax Number	:	251-471-7715

Provider Business Practice Location Address
First Line	:	2451 FILLINGIM STREET
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36617-2238
Country	:	US
Telephone Number	:	251-471-7790
Fax Number	:	251-471-7715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/12/2015

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