Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD60221603 | WA |
N | 2080P0201X | Pediatric Allergist | MD60221603 | WA |
NPI | 1043439730 |
---|---|
Provider Name | Gregory Owens JR. |
First Address | Vancouver, WA 98664-1913 |
Second Address | Vancouver, WA 98686-2719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 13/12/2011 |