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1053447250

NPI Code Detail

MEDICARE: DR. KENNETH RAY VANOWEN M.D.

MEDICARE: DR. KENNETH RAY VANOWEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	2007007216	MO
2	2084N0400X	Neurology Physician	04-34475	KS
3	2084N0400X	Neurology Physician	01058864A	IN
4	2084N0400X	Neurology Physician	T0028	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00427020	OTHER		MEDICARE RR PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053447250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH RAY VANOWEN M.D.

Provider Business Mailing Address
First Line	:	4141 VISTA RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2113
Country	:	US
Telephone Number	:	713-947-3100
Fax Number	:	713-947-6103

Provider Business Practice Location Address
First Line	:	4141 VISTA RD
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2113
Country	:	US
Telephone Number	:	713-947-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	09/25/2024

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Directions to “ DR. KENNETH RAY VANOWEN M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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