Provider Demographics
NPI:1386632404
Name:OWNBEY, TIMOTHY CRAIG (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:OWNBEY
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 1:2440 LOUISIANA BLVD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110
Mailing Address - Country:US
Mailing Address - Phone:505-389-1991
Mailing Address - Fax:505-389-1989
Practice Address - Street 1:2440 LOUISIANA BLVD NE STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110
Practice Address - Country:US
Practice Address - Phone:505-389-1991
Practice Address - Fax:505-389-1989
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34822084N0400X
NMA1097982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096070AMedicaid
OKG66850Medicare UPIN
OK100096070AMedicaid