Provider Demographics
NPI:1265614275
Name:OWEN, SCOTT RICHARD (PA)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:OWEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7344 E DEER VALLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7456
Mailing Address - Country:US
Mailing Address - Phone:480-513-1042
Mailing Address - Fax:480-513-1043
Practice Address - Street 1:7344 E DEER VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7456
Practice Address - Country:US
Practice Address - Phone:480-513-1042
Practice Address - Fax:480-513-1043
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ3770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3770OtherSTATE LICENSE