Provider Demographics
NPI:1366437154
Name:OWENS, JOE HOWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:HOWARD
Last Name:OWENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2012 BROOKSIDE DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4645
Mailing Address - Country:US
Mailing Address - Phone:423-392-6430
Mailing Address - Fax:423-392-6432
Practice Address - Street 1:2012 BROOKSIDE DR
Practice Address - Street 2:SUITE 9
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4645
Practice Address - Country:US
Practice Address - Phone:423-392-6430
Practice Address - Fax:423-392-6432
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-17
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDPM271213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351168Medicaid
VA246159OtherBCBS ANTHEM/VA
TN1366437154OtherNPI
TN4049239OtherBCBS TN
TN5203320001Medicare NSC
VA246159OtherBCBS ANTHEM/VA
TN3351168Medicare ID - Type Unspecified