Healthcare Provider Details

I. General information

NPI: 1053339069
Provider Name (Legal Business Name): DAVID W POWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LINE AVE
INVERNESS FL
34452-4606
US

IV. Provider business mailing address

PO BOX 2044
INVERNESS FL
34451-2044
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-8660
  • Fax: 352-726-9000
Mailing address:
  • Phone: 352-586-4275
  • Fax: 352-726-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberE-0131
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME0014112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: