Healthcare Provider Details

I. General information

NPI: 1033784988
Provider Name (Legal Business Name): ELIZA KAY OWENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZA KAY SMITH

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 E SUNSHINE ST
SPRINGFIELD MO
65804-2047
US

IV. Provider business mailing address

2730 E SUNSHINE ST
SPRINGFIELD MO
65804-2047
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-0600
  • Fax: 417-883-9443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024010467
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: