Healthcare Provider Details

I. General information

NPI: 1790028199
Provider Name (Legal Business Name): PATRICK ROSS OWENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR STE 402
BIRMINGHAM AL
35205
US

IV. Provider business mailing address

833 SAINT VINCENTS DR STE 402
BIRMINGHAM AL
35205-1613
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-9277
  • Fax: 205-212-3544
Mailing address:
  • Phone: 205-933-9277
  • Fax: 205-212-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number57.022811
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.37063
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: