Provider Demographics
NPI:1104834423
Name:OWENS, STEPHEN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
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 1:2800 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2040
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:
Practice Address - Street 1:262 MITYLENE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3548
Practice Address - Country:US
Practice Address - Phone:334-260-8511
Practice Address - Fax:334-260-8755
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15332174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506599OtherBLUE CROSS BLUE SHIELD
AL51520273OtherBLUE CROSS BLUE SHIELD
AL051519737Medicaid