Provider Demographics
NPI:1760504369
Name:POWERS, KIM BARTHOLOMEW (DO)
Entity Type:Individual
Prefix:MISS
First Name:KIM
Middle Name:BARTHOLOMEW
Last Name:POWERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 66TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2168
Mailing Address - Country:US
Mailing Address - Phone:727-541-0323
Mailing Address - Fax:727-541-0336
Practice Address - Street 1:7800 66TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2168
Practice Address - Country:US
Practice Address - Phone:727-541-0323
Practice Address - Fax:727-541-0336
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2303224OtherAETNA
FLF92528Medicare UPIN
80939Medicare ID - Type Unspecified