Provider Demographics
NPI:1255448783
Name:OWENS, HEATHER M (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1140 FRUIT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:OH
Mailing Address - Zip Code:45153-9738
Mailing Address - Country:US
Mailing Address - Phone:513-876-0610
Mailing Address - Fax:
Practice Address - Street 1:210 N. UNION STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-1313
Practice Address - Country:US
Practice Address - Phone:513-734-9050
Practice Address - Fax:513-734-9051
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.083151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437723Medicaid
H94770Medicare UPIN
OHOW7316061Medicare ID - Type Unspecified