Provider Demographics
NPI:1952718975
Name:OWENS, TRAVON (DPM)
Entity Type:Individual
Prefix:DR
First Name:TRAVON
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032-1404
Mailing Address - Country:US
Mailing Address - Phone:424-219-3697
Mailing Address - Fax:
Practice Address - Street 1:1500 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2100
Practice Address - Country:US
Practice Address - Phone:424-219-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-214213EP1101X
DEE1-0010276213E00000X
CT1141213EP1101X
PASC006603213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine