Provider Demographics
NPI:1407067119
Name:OWEN, RULON DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:RULON
Middle Name:DOUGLAS
Last Name:OWEN
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 1:7660 W. CHEYENNE AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:702-722-2665
Mailing Address - Fax:702-722-2605
Practice Address - Street 1:7660 W. CHEYENNE AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129
Practice Address - Country:US
Practice Address - Phone:702-722-2665
Practice Address - Fax:702-722-2605
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5531207Q00000X
NVDO2155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A55310Medicare ID - Type Unspecified
E08913Medicare UPIN