Individual
DR. FRED JOE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 NATURE WALK PARKWAY, SUITE 108, ST. AUGUSTINE, FL 32092
(904) 230-7180
(904) 230-7181
Mailing address
111 NATURE WALK PARKWAY, SUITE 108, ST. AUGUSTINE, FL 32092
(904) 230-7180
(904) 230-7181
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
ME 80996
FL
Other
Enumeration date
06/04/2007
Last updated
07/23/2010
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