Healthcare Provider Details

I. General information

NPI: 1407025331
Provider Name (Legal Business Name): BRIAN W OWENS CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 ROCKBRIDGE DR
KERNERSVILLE NC
27284-6844
US

IV. Provider business mailing address

540 ROCKBRIDGE DR
KERNERSVILLE NC
27284-6844
US

V. Phone/Fax

Practice location:
  • Phone: 336-402-1077
  • Fax:
Mailing address:
  • Phone: 336-402-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number107313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: