Provider Demographics
NPI:1861803264
Name:POWERS, CHARLES KENT III (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KENT
Last Name:POWERS
Suffix:III
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:352-376-4542
Mailing Address - Fax:
Practice Address - Street 1:5612 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3332
Practice Address - Country:US
Practice Address - Phone:352-376-4542
Practice Address - Fax:352-376-4959
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132034208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021744500Medicaid
FLOB926OtherFL MEDICARE