Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | S4665 | TX |
NPI | 1154717726 |
---|---|
Provider Name | Joshua Lee Owen |
First Address | San Antonio, TX 78258-4471 |
Second Address | San Antonio, TX 78215-7821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
409062301 | (05) | TX |