Provider Demographics
NPI:1881972651
Name:OWENS, GARY KENNETH (PA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:KENNETH
Last Name:OWENS
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 1:1900 N MILLS AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1444
Mailing Address - Country:US
Mailing Address - Phone:407-894-4880
Mailing Address - Fax:407-894-2364
Practice Address - Street 1:1900 N MILLS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1444
Practice Address - Country:US
Practice Address - Phone:407-894-4880
Practice Address - Fax:407-894-2364
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105813363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical