Provider Demographics
NPI:1255362760
Name:POWERS, MATTHEW P (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:POWERS
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 1:2420 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2523
Mailing Address - Country:US
Mailing Address - Phone:239-450-8138
Mailing Address - Fax:
Practice Address - Street 1:2420 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2523
Practice Address - Country:US
Practice Address - Phone:239-261-1005
Practice Address - Fax:239-262-1054
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL46550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11160WMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
FL11160VMedicare PIN