Provider Demographics
NPI:1790850493
Name:OWENS, DENNIS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7466
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-7466
Mailing Address - Country:US
Mailing Address - Phone:270-575-4551
Mailing Address - Fax:270-575-4560
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-575-4551
Practice Address - Fax:270-575-4560
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20868207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY160025054OtherRR MEDICARE
KY000000066139OtherBC BS
KY64208689Medicaid
KY64208689Medicaid
KY0310402Medicare PIN