Provider Demographics
NPI:1336121649
Name:OWEN, ROBERT CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARROLL
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 1:1600 WESTGATE CIRCLE
Mailing Address - Street 2:STE. 295
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8069
Mailing Address - Country:US
Mailing Address - Phone:615-778-0611
Mailing Address - Fax:615-778-0673
Practice Address - Street 1:1600 WESTGATE CIRCLE
Practice Address - Street 2:STE. 295
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8069
Practice Address - Country:US
Practice Address - Phone:615-778-0611
Practice Address - Fax:615-778-0673
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4298207KA0200X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I037535Medicare PIN
TNBO1446Medicare UPIN