Provider Demographics
NPI:1508838392
Name:POWELL, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 SE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0485
Mailing Address - Country:US
Mailing Address - Phone:352-732-0339
Mailing Address - Fax:352-732-3715
Practice Address - Street 1:2910 SE 3RD CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0485
Practice Address - Country:US
Practice Address - Phone:352-732-0339
Practice Address - Fax:352-732-3715
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46230207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCG7408OtherRAILROAD M/C GROUP #
FL54067OtherBC/BS OF FL PROVIDER #
FL592660405OtherTRICARE GROUP #
FL10D0272724OtherCLIA#
FLK1373OtherMEDICARE GROUP #
FL070001265OtherRAILROAD M/C PROVIDER #
FL592660405OtherTAX ID#
FL592660405OtherTRICARE GROUP #
FL54067BMedicare ID - Type UnspecifiedMEDICARE PROVIDER #