Healthcare Provider Details

I. General information

NPI: 1861572349
Provider Name (Legal Business Name): RICKY LAWAYNE OWERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS LOOP #300
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

PO BOX 415000 LBX 410604
NASHVILLE TN
37241-0604
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4554
  • Fax: 318-798-4581
Mailing address:
  • Phone: 318-798-4554
  • Fax: 318-798-4581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number201645
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: