Provider Demographics
NPI:1568464030
Name:OSBORN, CAROL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:461 E 200 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2102
Mailing Address - Country:US
Mailing Address - Phone:801-519-2461
Mailing Address - Fax:801-596-3785
Practice Address - Street 1:461 E 200 S
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2102
Practice Address - Country:US
Practice Address - Phone:801-519-2461
Practice Address - Fax:801-596-3785
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT175520-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD07731Medicare UPIN