Provider Demographics
NPI:1790223402
Name:OWENS PROFESSIONAL MEDICAL CLINIC
Entity Type:Organization
Organization Name:OWENS PROFESSIONAL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:346-206-4031
Mailing Address - Street 1:13688 BRETON RIDGE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-6085
Mailing Address - Country:US
Mailing Address - Phone:346-206-4031
Mailing Address - Fax:346-206-4037
Practice Address - Street 1:13688 BRETON RIDGE ST
Practice Address - Street 2:SUITE F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6085
Practice Address - Country:US
Practice Address - Phone:346-206-4031
Practice Address - Fax:346-206-4037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8385207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty