Provider Demographics
NPI:1619263324
Name:VINCENT, OWEN D (DO)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:D
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:8170 33RD AVE
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-967-6614
Mailing Address - Fax:651-653-2125
Practice Address - Street 1:1430 HIGHWAY 96 E
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3653
Practice Address - Country:US
Practice Address - Phone:952-967-6614
Practice Address - Fax:651-653-2125
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-09-26
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Provider Licenses
StateLicense IDTaxonomies
IADO-04547207Q00000X
WI61870-21207Q00000X
MN63626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine