Healthcare Provider Details

I. General information

NPI: 1952807349
Provider Name (Legal Business Name): OWEN PAUL GOLDSWORTHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/20/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

155 N FRESNO ST
FRESNO CA
93701-2302
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-6516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number20A17795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: