Provider Demographics
NPI:1174381560
Name:OWEN, JAMES DEAN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DEAN
Last Name:OWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E US HIGHWAY 52 STE C
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-8002
Mailing Address - Country:US
Mailing Address - Phone:317-460-1215
Mailing Address - Fax:
Practice Address - Street 1:210 E US HIGHWAY 52 STE C
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-8002
Practice Address - Country:US
Practice Address - Phone:317-460-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28216418A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine