Provider Demographics
NPI:1104828144
Name:OWENS, DANIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:OWENS
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7490
Mailing Address - Fax:843-777-7480
Practice Address - Street 1:101 S RAVENEL ST STE 300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2621
Practice Address - Country:US
Practice Address - Phone:843-777-7490
Practice Address - Fax:843-777-7480
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36280207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC362805Medicaid
AR169667001Medicaid
11000943Medicare PIN
SC362805Medicaid
ARP00633332OtherTRAVELERS MEDICARE
1100094Medicare PIN
11000942Medicare PIN
AR9418119OtherAETNA
11000944Medicare PIN
ID000010163990OtherBLUE SHIELD-ABERDEEN
000010163994OtherBLUE SHIELD-MCCAMMON
IDB6121OtherBLUE CROSS-AMERICAN FALLS
IDB6122OtherBLUE CROSS-ABERDEEN
IDB6123OtherBLUE CROSS-POCATELLO
AR5H227Medicare PIN
ID807070600Medicaid
000010163993OtherBLUE SHIELD - LAVA
ID000010163995OtherBLUE SHIELD POCATELLO
ID77109OtherBLUE CROSS-DOWNEY
IDB6120OtherBLUE CROSS-LAVA
11000941Medicare PIN
SCSC16886341Medicare PIN
ID000010163991OtherBLUE SHIELD AMERICAN FALL
AR5H227OtherBCBS
11000945Medicare PIN
IDB6119OtherBLUE CROSS-MCCAMMON