Provider Demographics
NPI:1053447250
Name:VANOWEN, KENNETH RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RAY
Last Name:VANOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-2113
Mailing Address - Country:US
Mailing Address - Phone:713-947-3100
Mailing Address - Fax:713-947-6103
Practice Address - Street 1:4141 VISTA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-2113
Practice Address - Country:US
Practice Address - Phone:713-947-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070072162084N0400X
KS04-344752084N0400X
IN01058864A2084N0400X
TXT00282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207435009Medicaid
KS200533040AMedicaid
P00427020OtherMEDICARE RR PIN
I47488Medicare UPIN
P00427020OtherMEDICARE RR PIN