Provider Demographics
NPI:1649278201
Name:OWEN, GRAVES T (MD)
Entity type:Individual
Prefix:DR
First Name:GRAVES
Middle Name:T
Last Name:OWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7200 WYOMING SPRINGS RD SUITE 400
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4304
Mailing Address - Country:US
Mailing Address - Phone:512-310-7246
Mailing Address - Fax:512-310-7667
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 400
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4304
Practice Address - Country:US
Practice Address - Phone:512-310-7246
Practice Address - Fax:512-310-7667
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0175208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
050057463RROtherRR MEDICARE
TX100192704Medicaid
81Z160OtherBCBS
144572XXOtherTHCS
TX81Z160Medicare PIN
144572XXOtherTHCS