Healthcare Provider Details

I. General information

NPI: 1396859666
Provider Name (Legal Business Name): LARRY SCOTT OWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 B ST SUITE 200
ANCHORAGE AK
99503-5925
US

IV. Provider business mailing address

4300 B ST SUITE 200
ANCHORAGE AK
99503-5925
US

V. Phone/Fax

Practice location:
  • Phone: 907-375-3355
  • Fax: 907-375-3351
Mailing address:
  • Phone: 907-375-3355
  • Fax: 907-375-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15758
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMEDS7584
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: