| Doctor Name: | DR. JERRY BRYAN OWEN |
| NPI Number: | 1073591350 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O |
| License Number: | F7019 |
| Business Practice Address: | 2200 Bergquist Dr, Suite 1 Attn: Credentials (cmc) Lackland Afb, TX - 782365300 |
| Business Phone Number: | 2102926002 |
| Business Fax Number: | 2102927964 |
| Mailing Address: | 8312 Traciney Blvd, SAN ANTONIO |
| State: | TX |
| Postal Code: | 782553536 |
| Phone Number: | 2106981375 |
| Fax Number: | |
| NPI Enumeration Date: | 01/06/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2083P0500X |
| License Number: | F7019 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Preventive Medicine |
| Taxonomy Specialization: | Preventive Medicine/Occupational Environmental Medicine |
| Taxonomy Definition: | A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the population from occupational and environmental conditions. |