Provider Demographics
NPI:1275820151
Name:OWEN, RYAN LEE (DO,)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
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 1:725 S DOBSON RD, STE 200
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6165
Mailing Address - Country:US
Mailing Address - Phone:480-899-7546
Mailing Address - Fax:
Practice Address - Street 1:725 S DOBSON RD STE 200
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5679
Practice Address - Country:US
Practice Address - Phone:480-899-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014924207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology