Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5221090-1205 | UT |
Y | 207Q00000X | Family Doctor | DR0051929 | CO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 5221090-1205 | UT |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | DR0051929 | CO |
N | 207RG0300X | Geriatric Medicine | DR0051929 | CO |
NPI | 1477676427 |
---|---|
Provider Name | Dr. Crystal Owens |
First Address | Grand Junction, CO 81501-2001 |
Second Address | Grand Junction, CO 81501-2001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 21/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000057906 | GROUP PIN (01) | UT |
I22251 | (02) | UT |
UT03672 | MEDICARE SUBMITTER ID NUM (01) | UT |