Provider Demographics
NPI:1528064615
Name:POWELL, WILLIAM STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEWART
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:141 TRYON RD
Practice Address - Street 2:SUITE B
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3099
Practice Address - Country:US
Practice Address - Phone:828-286-1445
Practice Address - Fax:828-286-1443
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38411208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8968686Medicaid
NC68686OtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NCP00940479OtherRAILROAD MEDICARE
NC2142810CMedicare PIN
NC68686OtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA
NCP00940479OtherRAILROAD MEDICARE