Provider Demographics
NPI:1700995313
Name:OWEN, ERIC G (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:OWEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0260
Mailing Address - Country:US
Mailing Address - Phone:360-748-0211
Mailing Address - Fax:360-740-4170
Practice Address - Street 1:1299 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8758
Practice Address - Country:US
Practice Address - Phone:360-748-0211
Practice Address - Fax:360-740-4170
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00083661OtherRAILROAD MEDICARE
WA0180115OtherLABOR & INDUSTRIES PROV #
WA9110OWOtherREGENCE PROVIDER #
Q07378Medicare UPIN
WA0180115OtherLABOR & INDUSTRIES PROV #