Provider Demographics
NPI:1043288368
Name:OSBORN, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 TENTH AVE
Mailing Address - Street 2:206
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-408-3900
Mailing Address - Fax:801-408-3909
Practice Address - Street 1:324 TENTH AVE
Practice Address - Street 2:206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-3900
Practice Address - Fax:801-408-3909
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176514-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT08835Medicaid
UT08835Medicaid
ID1131992Medicare PIN