Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 034917 | GA |
NPI | 1134195407 |
---|---|
Provider Name | Ralph G Owen JR. |
First Address | Evans, GA 30809-3000 |
Second Address | Evans, GA 30809-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000719056I | (05) | GA |
157315300 | EMPLOYMENT STANDARD (01) | |
5254104 | AETNA (01) | |
6406065 | CIGNA (01) | |
906573 | BLUE CROSS (01) | GA |
G26012 | (02) | |
P00195693 | MEDICARE RAILROAD (01) | GA |