Provider Demographics
NPI:1770501173
Name:OWENS, WILLIAM EARL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EARL
Last Name:OWENS
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 1:2425 PROPER ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-5394
Mailing Address - Country:US
Mailing Address - Phone:662-287-7785
Mailing Address - Fax:662-287-7876
Practice Address - Street 1:2425 PROPER ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-5394
Practice Address - Country:US
Practice Address - Phone:662-396-9447
Practice Address - Fax:662-396-9449
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS183542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04001036Medicaid
MS130000264Medicare ID - Type Unspecified
MS04001036Medicaid