Healthcare Provider Details

I. General information

NPI: 1881788206
Provider Name (Legal Business Name): WILLIAM B OWENS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY OWENS JR. M.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-7010
  • Fax: 207-662-7025
Mailing address:
  • Phone: 207-662-7010
  • Fax: 207-662-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number009397
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: