Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4298 | TN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4298 | TN |
NPI | 1336121649 |
---|---|
Provider Name | Dr. Robert Carroll Owen |
First Address | Brentwood, TN 37027-8069 |
Second Address | Brentwood, TN 37027-8069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 25/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BO1446 | (02) | TN |