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Individual

MR. MICHAEL TYLER OWEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
3401 4TH ST NW, ALBUQUERQUE, NM 87107-2423
(505) 994-5300
Mailing address
4949 SAN PEDRO DR NE APT 40, ALBUQUERQUE, NM 87109-2551
(575) 706-4389

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2023-0025
NM

Other

Enumeration date
05/31/2022
Last updated
07/13/2023
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