Provider Demographics
NPI:1902801863
Name:OWEN, MATTHEW BRYCE (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRYCE
Last Name:OWEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5728 MAJOR BLVD
Mailing Address - Street 2:SUITE 528
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7945
Mailing Address - Country:US
Mailing Address - Phone:407-352-2542
Mailing Address - Fax:407-352-2547
Practice Address - Street 1:5728 MAJOR BLVD
Practice Address - Street 2:SUITE 528
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7945
Practice Address - Country:US
Practice Address - Phone:407-352-2542
Practice Address - Fax:407-352-2547
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9450207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003812700Medicaid
FL003812700Medicaid
FLCR565YMedicare PIN