Healthcare Provider Details

I. General information

NPI: 1609000629
Provider Name (Legal Business Name): JOSEPH WILSON OWEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # HX304
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST # HX304
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5069
  • Fax: 859-257-5128
Mailing address:
  • Phone: 859-323-5069
  • Fax: 859-257-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2010017249
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number46655
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: