Basic Information
Provider Information
NPI: 1568756724
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OWENS
FirstName: ADAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 810 E 3RD ST SUITE 201
Address2:  
City: DURANGO
State: CO
PostalCode: 813015759
CountryCode: US
TelephoneNumber: 9707641790
FaxNumber: 9703757927
Practice Location
Address1: 810 E 3RD ST SUITE 201
Address2:  
City: DURANGO
State: CO
PostalCode: 813015759
CountryCode: US
TelephoneNumber: 9707641790
FaxNumber: 9703757927
Other Information
ProviderEnumerationDate: 06/06/2011
LastUpdateDate: 04/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X51500COY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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