Individual
MR. DEMARCCO OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1305 RIDGECREST RD, EDMOND, OK 73013-6035
(316) 647-7752
Mailing address
1305 RIDGECREST RD, EDMOND, OK 73013
(316) 647-7752
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200287120A
—
OK
Enumeration date
07/20/2012
Last updated
08/08/2012
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