MEDICARE: JEFFREY OWEN

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	2084P0800X	Psychiatry Physician	6838	OK

General Provider Information

NPI Number	:	1144636176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY OWEN

Provider Business Mailing Address
First Line	:	4870 S LEWIS AVE STE 240
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-5153
Country	:	US
Telephone Number	:	918-982-6524
Fax Number	:	539-399-7559

Provider Business Practice Location Address
First Line	:	4870 S LEWIS AVE STE 240
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74105-5153
Country	:	US
Telephone Number	:	918-982-6524
Fax Number	:	539-399-7559

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

Provider Enumeration Date	:	07/10/2014
Last Update Date	:	03/07/2025

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Directions to “ JEFFREY OWEN ” Practice Location

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