Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 36064 | KY |
NPI | 1003850736 |
---|---|
Provider Name | Dr. Robert Dale Owen JR. |
First Address | Lexington, KY 40504-3751 |
Second Address | Lexington, KY 40504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 14/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36064 | LICENSE (01) | KY |