| Doctor Name: | DR. FRED JOE POWELL |
| NPI Number: | 1609078542 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME 80996 |
| Business Practice Address: | 111 Nature Walk Parkway Suite 108 St. Augustine, FL - 32092 |
| Business Phone Number: | 9042307180 |
| Business Fax Number: | 9042307181 |
| Mailing Address: | 111 Nature Walk Parkway, Suite 108 ST. AUGUSTINE |
| State: | FL |
| Postal Code: | 32092 |
| Phone Number: | 9042307180 |
| Fax Number: | 9042307181 |
| NPI Enumeration Date: | 06/04/2007 |
| NPI Last Update Date: | 07/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | ME 80996 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |