Provider Demographics
NPI:1942221171
Name:R DOUGLAS OWEN DO INC
Entity Type:Organization
Organization Name:R DOUGLAS OWEN DO INC
Other - Org Name:RULON DOUGLAS OWEN DO
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-592-3885
Mailing Address - Street 1:244 N KAWEAH AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221
Mailing Address - Country:US
Mailing Address - Phone:559-592-3889
Mailing Address - Fax:
Practice Address - Street 1:244 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221
Practice Address - Country:US
Practice Address - Phone:559-592-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX55310Medicaid
CA00AX55310Medicaid
E08913Medicare UPIN