Provider Demographics
NPI:1407025331
Name:OWENS, BRIAN W (CFA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:OWENS
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ROCKBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6844
Mailing Address - Country:US
Mailing Address - Phone:336-402-1077
Mailing Address - Fax:
Practice Address - Street 1:540 ROCKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6844
Practice Address - Country:US
Practice Address - Phone:336-402-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107313246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant