Provider Demographics
NPI:1205854353
Name:OWEN, STEPHEN J (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:OWEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-9586
Mailing Address - Country:US
Mailing Address - Phone:740-395-8090
Mailing Address - Fax:
Practice Address - Street 1:1000 VETERANS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9586
Practice Address - Country:US
Practice Address - Phone:740-395-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0764810Medicaid
OHE36392Medicare UPIN
OH0764810Medicaid
OH0764810Medicaid