Basic Information
| Provider Information | |||||||||
| NPI: | 1396859666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 B ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995035925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073753355 | ||||||||
| FaxNumber: | 9073753351 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 B ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995035925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073753355 | ||||||||
| FaxNumber: | 9073753351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MEDS7584 | AK | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 15758 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.