Provider Demographics
NPI:1427076652
Name:OWENS, WILLIAM FRANCES (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANCES
Last Name:OWENS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 LEAR JET LN
Mailing Address - Street 2:STE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 LEAR JET LN STE 203
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2322
Practice Address - Country:US
Practice Address - Phone:518-250-5513
Practice Address - Fax:844-907-2966
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002360363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000491283002OtherBLUE SHIELD
NY060117000012OtherFIDELIS
NY060117000012OtherFIDELIS
NYR58025Medicare UPIN