Individual
ERIC G OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1299 BISHOP RD, CHEHALIS, WA 98532-8758
(360) 748-0211
(360) 740-4170
Mailing address
PO BOX 1267, CHEHALIS, WA 98532-0260
(360) 748-0211
(360) 740-4170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10004608
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0180115
LABOR & INDUSTRIES PROV #
WA
01
—
9110OW
REGENCE PROVIDER #
WA
01
—
P00083661
RAILROAD MEDICARE
—
Enumeration date
08/29/2006
Last updated
12/21/2007
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