Provider Demographics
NPI:1821063959
Name:POWELL, RODNEY E (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:E
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 1:1005 MAR WALT DR
Mailing Address - Street 2:CARDIOLOGY DEPARTMENT
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-862-6934
Mailing Address - Fax:850-862-6899
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:CARDIOLOGY DEPARTMENT
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-862-6934
Practice Address - Fax:850-862-6899
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2017-01-16
Deactivation Date:2006-08-03
Deactivation Code:
Reactivation Date:2007-08-30
Provider Licenses
StateLicense IDTaxonomies
FLME0038630207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040294000Medicaid
FL30688OtherBCBSFL
FL040294000Medicaid
FLD62203Medicare UPIN