Provider Demographics
NPI:1467985788
Name:OWENS, JOHN ELWOOD (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELWOOD
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2482 TROTTER RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-1950
Mailing Address - Country:US
Mailing Address - Phone:843-664-9787
Mailing Address - Fax:
Practice Address - Street 1:500 S COIT ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5221
Practice Address - Country:US
Practice Address - Phone:843-667-9947
Practice Address - Fax:843-667-0455
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 13023261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service