Provider Demographics
NPI:1962526988
Name:OWEN, HENRY MACK (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:MACK
Last Name:OWEN
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 1:222 TONGASS DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9416
Mailing Address - Country:US
Mailing Address - Phone:907-966-2411
Mailing Address - Fax:907-966-8444
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-2411
Practice Address - Fax:907-966-8444
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3529Medicaid
AK8EC534Medicare PIN
AK8EZ38CMedicare ID - Type Unspecified
AKF66412Medicare UPIN
AK8EC533Medicare PIN
AK8EC535Medicare PIN
AKMD3529Medicaid