Provider Demographics
NPI:1104897115
Name:POWERS, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9077 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3405
Mailing Address - Country:US
Mailing Address - Phone:772-335-4770
Mailing Address - Fax:772-335-4133
Practice Address - Street 1:9077 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3405
Practice Address - Country:US
Practice Address - Phone:772-335-4770
Practice Address - Fax:772-335-4133
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2020-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 55625207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10496OtherBLUE CROSS BLUE SHIELD
FL200012689Medicare PIN
FL10496YMedicare PIN
FL10496OtherBLUE CROSS BLUE SHIELD