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General NPI Number Information
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NPI Number | 1619263324
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Entity Type | Individual
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Provider Name | OWEN D VINCENT DO
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Gender | Male
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Dates
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Enumeration Date | 06/21/2011
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 707 BIELENBERG DR STE 108
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City | WOODBURY
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State | MN
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Zip | 55125-1427
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Country | US
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Telephone | 763-537-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 NORTHDALE BLVD NW STE 220
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City | COON RAPIDS
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State | MN
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Zip | 55433-3046
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Country | US
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Telephone | 763-537-6000
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Fax | 763-537-6666
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-04547
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 61870-21
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 63626
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License Number State | MN
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