Provider Demographics
NPI:1265463632
Name:OWEN, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OWEN
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 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:619 19TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-934-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11168207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009948225Medicaid
AL009948245Medicaid
AL009972665Medicaid
AL000016133OtherBLUE CROSS
AL000016133Medicaid
AL009948195Medicaid
AL009972565Medicaid
AL051518000OtherBLUE CROSS
AL051521045OtherBLUE CROSS
AL000093713OtherBLUE CROSS
AL000093713Medicaid
AL009936075Medicaid
AL009972545Medicaid
AL051521041OtherBLUE CROSS
AL051521043OtherBLUE CROSS
AL051521042OtherBLUE CROSS
AL009948185Medicaid
AL009948205Medicaid
AL009948215Medicaid
AL009948235Medicaid