Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 3212 | OR |
Y | 111NI0900X | Internist | 3212 | OR |
N | 111NN1001X | Nutrition | 3212 | OR |
NPI | 1083956536 |
---|---|
Provider Name | Dr. Michael Owen |
First Address | Beaverton, OR 97075-2316 |
Second Address | Beaverton, OR 97005-2049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 11/08/2014 |