Provider Demographics
NPI:1881743425
Name:OSBORNE, DENNIS M (DPM)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 A ST
Mailing Address - Street 2:# 4
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2354
Mailing Address - Country:US
Mailing Address - Phone:925-778-1800
Mailing Address - Fax:925-778-1877
Practice Address - Street 1:1205 A ST
Practice Address - Street 2:# 4
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2354
Practice Address - Country:US
Practice Address - Phone:925-778-1800
Practice Address - Fax:925-778-1877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE32220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11584Medicare UPIN