Provider Demographics
NPI:1790094753
Name:KIERAN, OWEN ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:ROBERT
Last Name:KIERAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1804 OAKLEY SEAVER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1925
Mailing Address - Country:US
Mailing Address - Phone:407-521-3600
Mailing Address - Fax:407-521-3603
Practice Address - Street 1:1804 OAKLEY SEAVER DR STE A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1925
Practice Address - Country:US
Practice Address - Phone:407-521-3600
Practice Address - Fax:407-521-3603
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14242208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1790094753OtherNPI
FL021151000Medicaid
PBB02OtherMEDICARE
FLUZ1EWOtherBCBS