Provider Demographics
NPI:1730115270
Name:OWSLEY, JIMIE DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:JIMIE
Middle Name:DIANNE
Last Name:OWSLEY
Suffix:
Gender:F
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:PO BOX 1876
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78403-1876
Mailing Address - Country:US
Mailing Address - Phone:361-887-9928
Mailing Address - Fax:361-887-9947
Practice Address - Street 1:810 MORGAN AVE APT 1
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2058
Practice Address - Country:US
Practice Address - Phone:361-887-9928
Practice Address - Fax:361-887-9947
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM30532086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181667002Medicaid
TXM3053OtherLICENSE
TX00X684Medicare PIN
TXI57471Medicare UPIN