Provider Demographics
NPI:1619904059
Name:RODNEY E POWELL MD PA
Entity Type:Organization
Organization Name:RODNEY E POWELL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:OEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-6934
Mailing Address - Street 1:965 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6759
Mailing Address - Country:US
Mailing Address - Phone:850-862-6934
Mailing Address - Fax:
Practice Address - Street 1:965 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6759
Practice Address - Country:US
Practice Address - Phone:850-862-6934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2010-07-20
Deactivation Date:2007-09-05
Deactivation Code:
Reactivation Date:2010-03-22
Provider Licenses
StateLicense IDTaxonomies
FLME0038630207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821063959OtherINDIVIDUAL NPI
FLD62203Medicare UPIN
FL1821063959OtherINDIVIDUAL NPI