1316938103 NPI number — DR. CHARLES C OWEN JR. M.D.

Table of content: DR. CHARLES C OWEN JR. M.D. (NPI 1316938103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316938103 NPI number — DR. CHARLES C OWEN JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWEN
Provider First Name:
CHARLES
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316938103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-424-2213
Provider Business Mailing Address Fax Number:
214-231-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 N WALDROP DR
Provider Second Line Business Practice Location Address:
STE 509
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-394-4300
Provider Business Practice Location Address Fax Number:
817-394-0200
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  L8154 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 081585402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F7167 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00N91F . This is a "BCBS GRP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 165919504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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