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NPI Code Detail

MEDICARE: DR. DAVID ROY OWENS DO

MEDICARE: DR. DAVID ROY OWENS DO
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
12085R0204XVascular & Interventional Radiology Physician036176665IL
22085R0204XVascular & Interventional Radiology Physician2022025613MO
3390200000XStudent in an Organized Health Care Education/Training Program
42085R0202XDiagnostic Radiology Physician036176665IL

General Provider Information

NPI Number : 1871952077
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID ROY OWENS DO
Provider Business Mailing Address
First Line : 2414 S 13TH ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63104-4317
Country : US
Telephone Number : 865-805-6034
Fax Number :
Provider Business Practice Location Address
First Line : 1015 BOWLES AVE
Second Line :
City : FENTON
State : MO
Zip : 63026-2394
Country : US
Telephone Number : 314-257-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 12/17/2025

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