Provider Demographics
NPI:1235348285
Name:OSBORN, NATHAN FORREST (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:FORREST
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 1:62968 O B RILEY RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9442
Mailing Address - Country:US
Mailing Address - Phone:541-728-0978
Mailing Address - Fax:541-728-0979
Practice Address - Street 1:62968 O B RILEY RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9442
Practice Address - Country:US
Practice Address - Phone:541-728-0978
Practice Address - Fax:541-728-0979
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-07-22
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2009-06-04
Provider Licenses
StateLicense IDTaxonomies
AZ774322084P0800X
ORMD1543862084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500640714Medicaid
OR500640714Medicaid