Healthcare Provider Details

I. General information

NPI: 1821063959
Provider Name (Legal Business Name): RODNEY E POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date: 08/03/2006
Reactivation Date: 08/30/2007

III. Provider practice location address

1005 MAR WALT DR CARDIOLOGY DEPARTMENT
FT WALTON BEACH FL
32547-6796
US

IV. Provider business mailing address

1005 MAR WALT DR CARDIOLOGY DEPARTMENT
FT WALTON BEACH FL
32547-6796
US

V. Phone/Fax

Practice location:
  • Phone: 850-862-6934
  • Fax: 850-862-6899
Mailing address:
  • Phone: 850-862-6934
  • Fax: 850-862-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0038630
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: