Provider Demographics
NPI:1831108661
Name:OWENS, DERRICK CHASE (MD)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:CHASE
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:D
Other - Middle Name:CHASE
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 192129
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-8513
Mailing Address - Country:US
Mailing Address - Phone:214-676-5097
Mailing Address - Fax:
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2231
Practice Address - Country:US
Practice Address - Phone:972-923-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48578Medicare UPIN