Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301094366 | MI |
NPI | 1003044652 |
---|---|
Provider Name | Gregory Robert Owens |
First Address | Medford, OR 97501-0227 |
Second Address | Grants Pass, OR 97527-5554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2009 |
Last Update Date | 19/06/2012 |