Individual
MARTY J OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
505 W JEFFERSON ST, BLOOMFIELD, IA 52537-1515
(641) 664-3602
(641) 664-3765
Mailing address
PO BOX 54, BLOOMFIELD, IA 52537-0054
(641) 664-3602
(641) 664-3765
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D048500
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053264
—
IA
01
—
26644
BCBS
IA
Enumeration date
08/30/2006
Last updated
07/08/2007
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