Provider Demographics
NPI:1215020060
Name:OSBORNE, DYAN J (DO)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:J
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:C3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-529-9603
Mailing Address - Fax:209-529-6610
Practice Address - Street 1:1421 OAKDALE RD
Practice Address - Street 2:STANISLAUS SURGICAL HOSPITAL
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-572-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6362207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX63620Medicaid
CA00AX63620Medicaid
020A63623Medicare PIN
F84443Medicare UPIN