Provider Demographics
NPI:1700809050
Name:POWELL, KEVIN LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMAR
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 1:4705 ALT 19 STE B
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1424
Mailing Address - Country:US
Mailing Address - Phone:727-935-6477
Mailing Address - Fax:727-935-6478
Practice Address - Street 1:4705 ALT 19 STE B
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1424
Practice Address - Country:US
Practice Address - Phone:727-935-6477
Practice Address - Fax:727-935-6478
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61640208600000X
FLME155682208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I025392Medicare PIN