Provider Demographics
NPI:1629193784
Name:RAYMOND L. OWEN, M.D. P.A.
Entity Type:Organization
Organization Name:RAYMOND L. OWEN, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-766-4329
Mailing Address - Street 1:2945 SOUTHWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4145
Mailing Address - Country:US
Mailing Address - Phone:940-766-4329
Mailing Address - Fax:940-767-3227
Practice Address - Street 1:2945 SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4145
Practice Address - Country:US
Practice Address - Phone:940-766-4329
Practice Address - Fax:940-767-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9909208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FL47Medicare ID - Type Unspecified
TXC20102Medicare UPIN