Healthcare Provider Details

I. General information

NPI: 1114133907
Provider Name (Legal Business Name): MICHAEL C OWENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E CHEROKEE AVE
ENID OK
73701-5823
US

IV. Provider business mailing address

427 E CHEROKEE AVE
ENID OK
73701-5823
US

V. Phone/Fax

Practice location:
  • Phone: 580-234-7246
  • Fax: 580-233-2223
Mailing address:
  • Phone: 580-234-7246
  • Fax: 580-233-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4609
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: