Healthcare Provider Details

I. General information

NPI: 1649461617
Provider Name (Legal Business Name): JAY GORDON OWENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10035 KNOX DR
OVERLAND PARK KS
66212-5340
US

IV. Provider business mailing address

3901 RAINBOW BLVD MS 40101
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-948-4376
  • Fax:
Mailing address:
  • Phone: 913-588-1902
  • Fax: 913-588-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9406880
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: