Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 35780-020 | WI |
NPI | 1043351182 |
---|---|
Provider Name | Richard Lee Owens |
First Address | Madison, WI 53711-2027 |
Second Address | Madison, WI 53711-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2007 |
Last Update Date | 08/07/2007 |