Healthcare Provider Details

I. General information

NPI: 1255368270
Provider Name (Legal Business Name): JOEL DOUGLAS OWENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ST. VINCENT CIRCLE
LITTLE ROCK AR
72205-5423
US

IV. Provider business mailing address

PO BOX 9150
PADUCAH KY
42002-9150
US

V. Phone/Fax

Practice location:
  • Phone: 501-552-3000
  • Fax: 501-552-4181
Mailing address:
  • Phone: 270-744-9600
  • Fax: 270-744-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC5816
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC5816
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: