Individual
ELMER GARI OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
HWY 18 & TAFT AVENUE, FAIRFAX, OK 74637-0219
(918) 642-3291
(918) 642-3694
Mailing address
12500 NE 36TH ST, CHOCTAW, OK 73020-9111
(405) 769-3221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
619
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100055050A
—
OK
Enumeration date
02/07/2007
Last updated
07/08/2007
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