Provider Demographics
NPI:1306874649
Name:OWENS, MICHAEL RAY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAY
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SYPHRONA CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-7055
Mailing Address - Country:US
Mailing Address - Phone:724-304-8200
Mailing Address - Fax:
Practice Address - Street 1:19 SYPHRONA CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-7055
Practice Address - Country:US
Practice Address - Phone:724-304-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2336770Medicaid
PA0012529150016Medicaid
WV3810013574Medicaid
PA0012529150016Medicaid
OH2336770Medicaid
E55842Medicare UPIN