Provider Demographics
NPI:1972305274
Name:OWEN, JACOB JOHN (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOHN
Last Name:OWEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 S LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7039
Mailing Address - Country:US
Mailing Address - Phone:972-249-8577
Mailing Address - Fax:
Practice Address - Street 1:1396 S LAKE CIR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7039
Practice Address - Country:US
Practice Address - Phone:972-249-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program