Individual
MR. FREDRICK MARK OWSLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
980 W IRONWOOD DR, STE 206, COEUR D ALENE, ID 83814-2668
(208) 664-0165
(208) 664-5695
Mailing address
980 W IRONWOOD DR, STE 206, COEUR D ALENE, ID 83814-2668
(208) 664-0165
(208) 664-5695
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6701
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002781300
—
ID
Enumeration date
11/09/2005
Last updated
09/16/2015
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