Provider Demographics
NPI:1467650986
Name:OSBORNE, LESTER KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:KEITH
Last Name:OSBORNE
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 1:13759 E PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3709
Mailing Address - Country:US
Mailing Address - Phone:602-371-2516
Mailing Address - Fax:602-371-2008
Practice Address - Street 1:11001 N BLACK CANYON HWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4757
Practice Address - Country:US
Practice Address - Phone:602-371-2516
Practice Address - Fax:602-371-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine