MEDICARE: DR. STEPHEN DOUGLAS OWENS M.D.

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	174400000X	Specialist	15332	AL
2	207W00000X	Ophthalmology Physician	15332	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51506599	OTHER	AL	BLUE CROSS BLUE SHIELD
2	51520273	OTHER	AL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104834423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN DOUGLAS OWENS M.D.

Provider Business Mailing Address
First Line	:	2800 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-2040
Country	:	US
Telephone Number	:	334-793-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 MITYLENE PARK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-3548
Country	:	US
Telephone Number	:	334-260-8511
Fax Number	:	334-260-8755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	06/24/2022

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