Healthcare Provider Details

I. General information

NPI: 1720588478
Provider Name (Legal Business Name): ROBERT WILLIAM OWENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703-7440
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703-7440
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5634
  • Fax:
Mailing address:
  • Phone: 907-361-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-21138
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD61680469
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: