Provider Demographics
NPI:1093081895
Name:OWENS, MARVIN D
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:D
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15497 COUNTY ROAD 1700
Mailing Address - Street 2:
Mailing Address - City:ROFF
Mailing Address - State:OK
Mailing Address - Zip Code:74865-9022
Mailing Address - Country:US
Mailing Address - Phone:580-310-4771
Mailing Address - Fax:580-371-2056
Practice Address - Street 1:15497 COUNTY ROAD 1700
Practice Address - Street 2:
Practice Address - City:ROFF
Practice Address - State:OK
Practice Address - Zip Code:74865-9022
Practice Address - Country:US
Practice Address - Phone:580-310-4771
Practice Address - Fax:580-371-2056
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health