Provider Demographics
NPI:1023171964
Name:OSBORNE, PEYTON EDWARD (MD)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:EDWARD
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 1:5909 N BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7322
Mailing Address - Country:US
Mailing Address - Phone:405-553-3367
Mailing Address - Fax:
Practice Address - Street 1:5909 N BARNES AVE
Practice Address - Street 2:301 N. HARVEY
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7322
Practice Address - Country:US
Practice Address - Phone:405-553-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK100202083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine