Provider Demographics
NPI:1578788535
Name:OWENS, MARY BRINSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:BRINSON
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY BRINSON
Other - Middle Name:BOYTE
Other - Last Name:HARGRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P O BOX 1000 DEPT 457
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-387-5153
Practice Address - Street 1:1325 EASTMORELAND AVE STE 370
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7542
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-387-5153
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6092208600000X
TN49941208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery