1326006339 NPI number — KURT M OSBORN MD

Table of content: KURT M OSBORN MD (NPI 1326006339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326006339 NPI number — KURT M OSBORN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORN
Provider First Name:
KURT
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326006339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2828 ONEIL LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95503-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-443-9385
Provider Business Mailing Address Fax Number:
707-443-0258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 ONEIL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-443-9385
Provider Business Practice Location Address Fax Number:
707-443-0258
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  C34660 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084S0012X , with the licence number: C34660 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130004936 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00C346600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0165083 . This is a "DEPT OF LABOR & INDUSTRIE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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