Provider Demographics
NPI:1275599631
Name:OSBORN, JOHN PILGRIM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PILGRIM
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1101 MADISON ST STE 800
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-215-2700
Practice Address - Fax:206-215-2702
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010548912080P0214X
VAMD341092080P0214X
WA287192080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6716865Medicaid
VA6715397Medicaid
VA6707297Medicaid
VA6711006Medicaid
VA6716369Medicaid
VA6707297Medicaid