Provider Demographics
NPI:1356331094
Name:OWEN, DAVID GERARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GERARD
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 1:615 WEST 39TH STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-8001
Mailing Address - Country:US
Mailing Address - Phone:308-865-2277
Mailing Address - Fax:308-865-2523
Practice Address - Street 1:615 WEST 39TH STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8001
Practice Address - Country:US
Practice Address - Phone:308-865-2277
Practice Address - Fax:308-865-2523
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20991207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00076OtherBCBS
NE47077661913Medicaid
275426Medicare ID - Type Unspecified
NE47077661913Medicaid
098108Medicare ID - Type Unspecified