MEDICARE: DOUGLAS G OWEN, MD, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	23349	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073810875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS G OWEN, MD, PSC

Provider Business Mailing Address
First Line	:	312 JASON DR
Second Line	:	SUITE #5
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-623-5070
Fax Number	:	859-623-2117

Provider Business Practice Location Address
First Line	:	312 JASON DR
Second Line	:	SUITE #5
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-623-5070
Fax Number	:	859-623-2117

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS G OWEN
Credential	:	M.D.
Telephone Number	:	859-623-5070

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/18/2011

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