Individual
STANFORD ALLEN OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3300 15TH ST, GULFPORT, MS 39501-3901
(228) 864-9669
(228) 864-9774
Mailing address
3300 15TH ST, GULFPORT, MS 39501-3901
(228) 864-9669
(228) 864-9774
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
08597
MS
207R00000X
Internal Medicine Physician
013830
LA
207R00000X
Internal Medicine Physician
Primary
08597
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00017546
—
MS
01
—
110115663
RAILROAD MEDICARE
LA
01
—
110121961
RAILROAD MEDICARE
MS
05
—
1198455
—
LA
Enumeration date
11/29/2005
Last updated
09/04/2014
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