MEDICARE: DR. CHARLES TAYLOR OWENS II MD

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	207RN0300X	Nephrology Physician	Q0143	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	Q0143	TX

General Provider Information

NPI Number	:	1366672594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES TAYLOR OWENS II MD

Provider Business Mailing Address
First Line	:	5910 N CENTRAL EXPY STE 1680
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-0936
Country	:	US
Telephone Number	:	697-505-1024
Fax Number	:	214-420-9353

Provider Business Practice Location Address
First Line	:	5910 N CENTRAL EXPY STE 1680
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-0936
Country	:	US
Telephone Number	:	469-750-5102
Fax Number	:	214-420-9353

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

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	02/20/2025

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