Healthcare Provider Details

I. General information

NPI: 1194042234
Provider Name (Legal Business Name): STUART CAMERON OWENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STUART OWENS MD

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/25/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LAKELAND HILLS BLVD
LAKELAND FL
33805-1946
US

IV. Provider business mailing address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 863-682-0027
  • Fax:
Mailing address:
  • Phone: 813-871-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME140987
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME140987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: