Provider Demographics
NPI:1679684138
Name:OWEN, JULIAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:LEE
Last Name:OWEN
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 1:297 HIGHWAY 51
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3423
Mailing Address - Country:US
Mailing Address - Phone:601-856-2598
Mailing Address - Fax:601-856-4459
Practice Address - Street 1:297 HIGHWAY 51
Practice Address - Street 2:SUITE B
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3423
Practice Address - Country:US
Practice Address - Phone:601-856-2598
Practice Address - Fax:601-856-4459
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011808Medicaid