=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629193784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYMOND L. OWEN, M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2945 SOUTHWEST PKWY
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76308-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-766-4329
-----------------------------------------------------
Fax | 940-767-3227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2945 SOUTHWEST PKWY
-----------------------------------------------------
City | WICHITA FALLS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76308-4145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-766-4329
-----------------------------------------------------
Fax | 940-767-3227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RAYMOND L OWEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-766-4329
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | F9909
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------