Healthcare Provider Details

I. General information

NPI: 1760860423
Provider Name (Legal Business Name): STEFAN OSBORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 01/16/2024
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD E STE 604
TUSCALOOSA AL
35401
US

IV. Provider business mailing address

3901 GREENSBORO AVE STE A
TUSCALOOSA AL
35405
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-6925
  • Fax: 205-759-6926
Mailing address:
  • Phone: 205-333-4655
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.45029
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: