Provider Demographics
NPI:1710143821
Name:OWEN, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
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 1:707 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1801
Mailing Address - Country:US
Mailing Address - Phone:251-554-1542
Mailing Address - Fax:334-493-5705
Practice Address - Street 1:702 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-5704
Practice Address - Fax:334-493-5705
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016712207X00000X
AL43694207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL305474Medicaid
ALA15444AOtherMEDICARE
CA123587OtherCA LICENSE
AL43694OtherAL MEDICAL LICENSE