Provider Demographics
NPI:1538341672
Name:OWENS, JASON BARRY (LMT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:BARRY
Last Name:OWENS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5505
Mailing Address - Country:US
Mailing Address - Phone:863-944-4564
Mailing Address - Fax:
Practice Address - Street 1:226 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5505
Practice Address - Country:US
Practice Address - Phone:863-944-4564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist