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Individual

MR. RANDALL LEE OWEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
9 WASHINGTON AVE, HAMDEN, CT 06518-3267
(203) 865-6784
(203) 865-6788
Mailing address
7 MONTOYA DR, BRANFORD, CT 06405-2533
(475) 434-1183

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110004314
VA
363A00000X
Physician Assistant
23.003095
CT
363A00000X
Physician Assistant
MA056252
PA
363AM0700X
Medical Physician Assistant
23.003095
CT
363AS0400X
Surgical Physician Assistant
Primary
23.003095
CT

Other

Enumeration date
07/25/2013
Last updated
06/29/2021
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