Healthcare Provider Details

I. General information

NPI: 1871751602
Provider Name (Legal Business Name): ANTHONY OWUSU II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W PARKER RD SUITE 200
PLANO TX
75093-8171
US

IV. Provider business mailing address

13409 NW MILITARY HWY STE 211
SHAVANO PARK TX
78231-1865
US

V. Phone/Fax

Practice location:
  • Phone: 972-608-5186
  • Fax:
Mailing address:
  • Phone: 210-763-7149
  • Fax: 210-251-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberP6882
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: