Healthcare Provider Details

I. General information

NPI: 1255347233
Provider Name (Legal Business Name): RAYMOND L OWNBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR ROOM 1477
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR ROOM 1477
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1481
  • Fax: 954-262-3753
Mailing address:
  • Phone: 954-262-1481
  • Fax: 954-262-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME69400
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberME69400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: