Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | 38158 | NC |
NPI | 1366427411 |
---|---|
Provider Name | John Owen |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 15/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810000437 | (05) | WV |
4855 | PARTNERS (01) | NC |
5693482 | AETNA (01) | |
6037615 | (05) | VA |
64141 | MEDCOST (01) | NC |
64415 | BCBS (01) | NC |
8964415 | (05) | NC |
C09914 | (02) | |
Q38158 | (05) | SC |