Provider Demographics
NPI:1831143247
Name:OSUMI, ALAN K (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:K
Last Name:OSUMI
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 3099
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2552
Mailing Address - Country:US
Mailing Address - Phone:928-634-0665
Mailing Address - Fax:928-634-0337
Practice Address - Street 1:300 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2812
Practice Address - Country:US
Practice Address - Phone:520-417-3104
Practice Address - Fax:520-417-3108
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ230632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ199647Medicaid
AZF14131Medicare UPIN
AZ199647Medicaid