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General NPI Number Information
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NPI Number | 1144432402
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Entity Type | Individual
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Provider Name | BRIAN KEITH POWELL DO
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 12420 130TH AVE
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City | LARGO
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State | FL
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Zip | 33774-1919
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Country | US
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Telephone | 727-824-8181
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Fax | 727-587-7739
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Provider Business Mailing Address
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Address Line | PO BOX 10549
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City | ST PETERSBURG
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State | FL
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Zip | 33733-0549
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Country | US
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Telephone | 727-824-8181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101016675
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12134
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License Number State | FL
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