Provider Demographics
NPI:1366500464
Name:OWEN, SYLVIA A (MD)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:A
Last Name:OWEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FOUR MILE DR STE 7
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2655
Mailing Address - Country:US
Mailing Address - Phone:406-314-6336
Mailing Address - Fax:406-890-6711
Practice Address - Street 1:40 FOUR MILE DR STE 7
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2655
Practice Address - Country:US
Practice Address - Phone:406-314-6336
Practice Address - Fax:406-890-6711
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10806207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00143741Medicaid
MT00143741Medicaid
G92670Medicare UPIN