Healthcare Provider Details

I. General information

NPI: 1942221171
Provider Name (Legal Business Name): R DOUGLAS OWEN DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N KAWEAH AVE
EXETER CA
93221
US

IV. Provider business mailing address

244 N KAWEAH AVE
EXETER CA
93221
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-3889
  • Fax:
Mailing address:
  • Phone: 559-592-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5531
License Number StateCA

VIII. Authorized Official

Name: R DOUGLAS OWEN
Title or Position: PRES
Credential: DO
Phone: 559-592-3885