Provider Demographics
NPI:1467016030
Name:OWENS, LANDON WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:LANDON
Middle Name:WAYNE
Last Name:OWENS
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:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - Street 2:14 MEDICAL PARK, STE 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-7088
Mailing Address - Fax:803-434-3946
Practice Address - Street 1:EMERGENCY MEDICINE DEPARTMENT
Practice Address - Street 2:14 MEDICAL PARK, STE 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-7088
Practice Address - Fax:803-434-3946
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL82342207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine