Basic Information
| Provider Information | |||||||||
| NPI: | 1477676427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702981782 | ||||||||
| FaxNumber: | 9706928301 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815012001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702981782 | ||||||||
| FaxNumber: | 9706928301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5221090-1205 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | 5221090-1205 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207QH0002X | DR0051929 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RG0300X | DR0051929 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207Q00000X | DR0051929 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000057906 | 01 | UT | GROUP PIN | OTHER | UT03672 | 01 | UT | MEDICARE SUBMITTER ID NUM | OTHER |